Stammering and cognate defects of speech

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STAMMERING AND COGNATE
DEFECTS OF SPEECH

STAMMERING

AND COGNATE DEFECTS

OF SPEECH

BY
C. S. BLUEMEL

VOLUME I
THE PSYCHOLOGY OF STAMMERING

NEW YORK
G. E. STECHERT AND COMPANY

LONDON — LEIPZIG — PARIS

COPYRIGHT, 1913,
BY C. S. BLUEMEL.

All rights restrvtd.

Hurfoooli

J. 8. Cashing Co. — Berwick A Smith Co.
Norwood, Mass., U.S.A.

PREFACE

FIVE years ago the author began a systematic in-
vestigation into the cause of stammering. In his
preliminary notes he wrote as follows :

" The true theory of causality must explain all the facts. It
must explain the fact —

" That the stammerer can usually sing without difficulty.

"That the stammerer can often speak well when alone.

" That the stammerer is usually fluent when speaking in con-
cert with other people.

"That the stammerer can usually repeat fluently the words
that are pronounced for him by another person by way of
assistance.

" That the stammerer can usually repeat a word that he has
eventually stammered out.

" That consonants followed by short vowels are more difficult
for the stammerer than consonants followed by long vowels.

" That consonants at the end of a word never occasion diffi-
culty.

" That the stammerer may have difficulty on words that com-
mence with vowels.

" That the speech-defect may assume the most diverse forms,
being in one case passive, and in another active and boister-
ous."

" That one can stammer in thought as well as in speech.

" That there are more male than female stammerers.

" That stammering is rarely acquired after the fifteenth year."
Etc., etc.

The theory of causality that the author has arrived
at affords what appears to be a satisfactory explana-
tion of the various paradoxes mentioned. The theory
has been developed in large part as the result of in-

vi PREFACE

trospective evidence, — evidence as indispensable as
it was uncoveted.

The theoretical discussion of the causality and
psychology of stammering is presented in the first
volume of this book.

In the second volume the author has reviewed and
criticised the systems at present employed in treating
stammering in Europe and America. He has thus
fulfilled, at a somewhat late date, the wish that Schul-
thess and some of his contemporaries expressed nearly
a century ago — that some one would embody in a
single volume all known systems applicable to the treat-
ment of stammering. But lest the words " all known
systems" should imply too much, let the author add
that he does not profess to be omniscient ; and, fur-
ther, that the systems that he has reviewed are merely
those that he knows to be current or to have been
recently current in the therapy of stammering. The
author has made no attempt to undertake an his-
torical review, since this field has been effectively
covered by Hunt in his " Stammering and Stutter-
ing." The contemporaneous systems given repre-
sent, however, the principal methods of the United
States of America, Canada, the British Isles, France,
Switzerland, Germany, Belgium, Holland, Denmark,
Scandinavia, Russia, and Austria. These systems
are therefore thoroughly representative of those em-
ployed in the civilized world.

The systems cited in this review have not, as a

PREFACE vii

rule, been given for their sovereign merit. Indeed,
many of the systems are entirely devoid of merit;
they have been recorded merely because they are the
gold bricks that are daily sold to stammerers by an
infamous fraternity of " speech specialists." These
wretched systems — and, indeed, most elocutionary
systems — must inevitably become obsolete with the
advancement of the psychological investigation of
stammering. But meanwhile progress is hampered
by charlatans, who rob the stammerer and bring
everybody and everything connected with the treat-
ment or investigation of stammering into disrepute.
Manifestly it is incumbent upon stammerers them-
selves to remedy these conditions.

A glossary has been appended to the second vol-
ume of the book. This has been made sufficiently
comprehensive to render the book available to the
youthful stammerer.

The author is indebted to Professor V. A. C. Hen-
mon (of the Department of Psychology at the Uni-
versity of Wisconsin) and to Professor Lawrence W.
Cole (of the Department of Psychology at the Uni-
versity of Colorado) for valuable criticisms of the first
volume of this monograph. The author is also in-
debted to the numerous friends that have in various
ways and at various times assisted him in the prep-
aration of the work.

C. S. B.

BOULDER, COLORADO,
October, 1912.

TABLE OF CONTENTS

CHAPTER I

PACK

INTRODUCTION i

CHAPTER II
MENTAL TYPES : EYE-MIND EDNESS, EAR-MINDEDNESS, ETC. 25

CHAPTER III
THE VERBAL IMAGE 40

CHAPTER IV
THE BRAIN 61

CHAPTER V

THE RELATION BETWEEN MENTAL IMAGERY AND VOL-
UNTARY SPEECH 86

CHAPTER VI
IMPAIRMENT OF THE BRAIN-CENTRES: APHASIA . . 106

CHAPTER VII

STAMMERING 181

ix

TABLE OF CONTENTS
CHAPTER VIII

'FACE

MENTAL CONFUSION IN STAMMERING .... 279

*-^— -^

CHAPTER IX
FEAR AND AUTO-SUGGESTION . , . . . .291

CHAPTER X
COROLLARIES 334

THE PSYCHOLOGY OF
STAMMERING

CHAPTER I

INTRODUCTION

STAMMERING and cognate defects of speech have in
the past been studied almost exclusively in their
physical manifestations. The point of view has been
that of physiology. In the present work the subject
will be considered primarily in its mental aspect.
The point of view will be that of psychology. For
this reason it will be necessary at the outset to con-
sider a few of the fundamental principles of psychology
itself, and the meanings of the psychological terms that
will occur most frequently in this monograph.1

PSYCHOLOGY

Psychology is commonly defined as the science of
mental life, or the science of consciousness. It is the
study of the mental processes, — of their nature and
function.

1 A complete glossary is also given at the end of the second volume.

i

2 THE PSYCHOLOGY OF STAMMERING

SENSATION

By sensation, the psychologist means the conscious-
ness arising from the stimulation of one of the bodily
sense-organs. One has sensations of sight as ether-
waves impinge upon the retina of the eye ; sensations
of sound as air- vibrations strike the drum of the ear ;
sensations of smell when free particles of matter,
floating in the atmosphere, stimulate the olfactory
nerves ; and so on.

The senses were formerly considered to be five in
number, — sight, hearing, feeling, taste, and smell.
To-day the number of senses recognized by the psy-
chologist is in the neighborhood of eighteen. Each
is regarded as an elementary sense with special end-
organs conveying the sensory current to the brain.
"Feeling" (or touch) is differentiated into elementary
sensations of pressure, pain, warmth, and cold.
Closely allied to this group are the kinaesthetic sensa-
tions, — sensations involved during muscular activity.
The kinaesthetic sensations are conveyed to the brain
by sensory nerves found in the muscles, tendons, and
joints. These sensations are felt in the arm as one
lifts a heavy weight ; they are felt chiefly in the fingers
and forearm as one clenches the fist ; they are detected
in the lips and tongue during speech. The organic
sensations may be included as further subdivisions of
"feeling." They are sensations from within the body

INTRODUCTION 3

itself, — feelings of hunger, thirst, and nausea, and
sensations from the respiratory and circulatory sys-
tems. (These sensations are distinctly emotional in
their coloring. They will be considered in their rela-
tion to the emotions in Chapter IX.) The static sen-
sations report the movements of the body as a whole.
A sensation is sometimes spoken of as an impression.

MENTAL IMAGES

Sensations arise as the result of the actual stimula-
tion of the sense-organs. They may, however, be re-
vived in memory quite independently of the stimulus,
in which case they are known as mental images. Men-
tal images are often dim and fugitive, but in dreams
and hallucinations they are sufficiently intense to be
mistaken for actual sensations. During the waking
state the sensations that one experiences are usually
too vivid to allow mental images to come conspicu-
ously to the foreground of consciousness. However,
as one is sitting in perfect quietness in the dark,
mental images frequently present themselves with
considerable clearness. In revery one reviews old
scenes and scans the faces of absent friends; one
hears absent voices, and enjoys music that comes
back in thought.

These mental images are not restricted to any
particular field of sensation ; they may represent any
sensation that has occurred in consciousness. They

4 THE PSYCHOLOGY OF STAMMERING

are not the mere habitants of dreams, nor is there
anything poetic or fantastic in their nature. They
are the material with which we think ; and they are
just as indispensable for the solution of a problem in
geometry as they are for the production of an artist's
masterpiece.

The visual image is easily recognized if one glances
at some object — a picture, for example — and im-
mediately closes the eyes. There is no definite point
in time at which the sensation can be said to vanish ;
certainly it does not terminate with the closing of the
eyes. For a moment the mental picture is present
with vivid color and accurate detail. One can examine
it for points that escaped observation during actual
vision. Strictly speaking, this mental picture is an
after-sensation. It is called the primary mental
image, in contradistinction to the secondary image,
— the re-called image, or memory-image proper.1
Memory-images differ from sensations mainly in
the fact that they are usually less distinct. These
secondary visual images are present in the mind as
one recalls any visual experience, — as one sketches
a scene from memory, for instance. Artists frequently
have so vivid a memory for visual impressions that

1 The visual after-image is often a negative image ; i.e. there is
an inversion of light and shade, as in the photographic negative.
In the negative after-image the spectral colors are replaced by their
complementary colors.

INTRODUCTION 5

they are able to paint, with the greatest accuracy of
detail and color, scenes that they have not beheld
for years.

Visual images are usually clearest the first moment
they arise in consciousness. As a rule, they do not
become clearer with mental fixation. In this respect
the visual image might be compared to the visual
impression that one gets from the sun, or a brilliant
light flashing out in the darkness. For an instant
the vision is distinct, but it melts in a moment to
a shapeless blur. In many cases the analogy will
not hold. Some people can scrutinize their visual
images at will ; with others the image is not clear even
at the moment of its first appearance in consciousness.
Under abnormal conditions the mental image may
assume the vividness of an actual sensation. In
this case there is usually an "hallucination." The
condition is pathological, and does not frequently
occur. To it may be attributed many of the super-
natural phenomena that excite the wonder of the
credulous. It is safe to say that no self-respecting
ghost would haunt anything but a mind affected by
a disordered liver. Frequently the subject of such
an experience is fully aware of the hallucinatory
character of the sights that he sees or the sounds that
he hears. In this case he is said to experience a
"pseudo-hallucination."

Auditory images are present in one's memory of

6 THE PSYCHOLOGY OF STAMMERING

sounds. One listens to "ear-haunting" tunes. A
person picks up a musical score; and, as he reads
the notes, hears the tune in mental imagery. A
musician may compose music in a train, jotting down
the notes as the strains of music rise in his mind.
One may listen in memory to the commoner physical
sounds, hearing in auditory images the rumble of
a wagon in the street or the clop-clop of horses' hoofs.
After a tedious train journey many people hear for
hours the clangor and rumble of the train.1

In audition, again, we have the primary mental
image, — occurring in the form of a mental "echo."
The primary memory is often conspicuous where the
secondary memory for sounds is deficient.

Tactual images (or touch memories) are often quite
clear when they reflect distinctive sensations. One
"feels" the soft, cold petals of a rose as it is (in imagi-
nation) touched to the lips. One can recall the cold,
smooth feeling of marble or the soft feeling of velvet,
and mentally contrast these feelings with the rough
feeling of sandpaper. One can imagine the sensation
that would result from plunging the hands into hot
water, or the freezing chill one would experience on
falling through the ice. (These last two are, strictly
speaking, thermal images.) One may have images

1 People differ greatly in their capacity for recalling the experi-
ences of the different senses. This point will be considered in Chap-
ter II in the discussion of mental types.

INTRODUCTION 7

of pain whilst listening to the vivid description of
an accident ; and one may imagine the pain of running
broken glass into the fingers or cutting the fingers with
a knife.

Gustatory images arise in the mind as one listens to
the description of a feast. The writer recently read
an account of an antarctic expedition in which the
explorers, when their pemmican was low, would
amuse themselves for hours by describing by turns the
sumptuous feasts they would enjoy upon their return
to civilization. After the descriptions they would
vote upon the menus. There was roast turkey,
steaming-hot plum pudding, and numberless other
things that would appeal to starving men. The
pleasure of the pastime was, of course, in the play of
the gustatory imagery.

Olfactory images are often present in the stream of
consciousness. One may recall in mental imagery
the smell of burning tobacco, of cooking bacon, the
odor of a rose, of cheese, of garlic, and of numerous
other objects that have occasioned olfactory sensa-
tions.

Kincesthetic, or motor, images will occupy a posi-
tion of prominence in later discussions. They are
the memories of muscular movements, — memories
of the muscular feelings involved in clenching the
fist, in flexing or extending the arm ; they are images
of the movements made in writing, in playing the

8 THE PSYCHOLOGY OF STAMMERING

piano, and in speaking ; they are, in fact, the remem-
bered feelings of any muscular movement whatever.
People that have lost an arm can often mentally
move the lost hand and work the missing fingers.
These movements occur, of course, in kinaesthetic
imagery.

Mental images are representative of past sensa-
tions. It is quite impossible for one to imagine a
sensation that has not been experienced. A man that
is born blind can never imagine the sensations of
sight. A man that has not looked at the moon
through a telescope cannot imagine what the ap-
pearance of the moon would be. A man that has
never heard an Indian tom-tom can have no auditory
image that represents the sound. A man that is
born deaf has no auditory imagery whatever. Not
only is he unable to imagine sounds, but he is totally
unable to imagine what sound is like. A person that
is born deaf remains dumb because he has never
heard words, and is consequently unable to call up
word-images in his mind.1

Mental images may, however, be recombined so
that the collocation is original. One can imagine
a winged horse, without having seen such a beast.
But both the horse and the wings have occurred
separately in experience. One pictures to himself

1 This kst statement will be modified later. See pp. 46 ff. and p. 95.

INTRODUCTION 9

a purple moon, — a thing apparently original. Yet
he has formerly seen the moon and experienced the
color purple. He has merely recombined elements
of his past experience. In the last analysis, the ele-
ments of any combination of mental imagery will
be found to be reproductions of one's former sensations.

Imagination is called productive, or constructive,
when it involves an original collocation of mental
images. It is termed reproductive when it involves
a mere reproduction of sensations — in the arrange-
ment in which they occurred. Reproductive im-
agination is thus practically identical with memory.
However, the mere duplication of sensations in mental
imagery is not memory. There is necessary, in addi-
tion, the knowledge of the fact that the mental images
portray former experiences.

A mental image is sometimes referred to as an idea.
Strictly speaking, it is an idea only when it is con-
sidered in relation to its meaning.

ASSOCIATION

The association of ideas in the mind is due largely
to previous experience. If two sensations have
occurred together, the mental image of the one is
likely to redintegrate, or recall, the mental image of
the other. The phenomenon is due to mental or
neural habit. The tunes of the English and German
national anthems and the American national song,

io THE PSYCHOLOGY OF STAMMERING

"America," are identical. When the German hears
this particular air, he immediately thinks of the
words "Heil Dir im Siegerkranz " ; the American,
on hearing the melody, associates it with the words
"My Country, 'tis of Thee"; and the Englishman
associates the same tune with " God save our Gracious
King." In each case the associations are due solely
to experience : the words and the tune have occurred
together in the past. Again, one picks up a volume
of Milton, and in a few seconds inquires the name of
the last Emperor of China. What is the connection ?
The book suggested printing ; China was thought of
as the home of printing; the interest then turns to
the country's political affairs, and prompts the ques-
tion concerning the emperor. The associations are
due to contiguity.

Ideas thus suggest one another when the experiences
that they represent have been contiguous either in
time or in space. In passing a certain house one is
reminded of the people that live there. The associa-
tion is one of spatial contiguity. Similarly, an orange
reminds the town-bred man of a fruiterer's shop ;
while it reminds the orange-grower of his orange
groves. In each case the associations are due to the
fact that the objects thought of have been adjacent
in space. By temporal contiguity an orange-grove
may remind one of a toothache for the reason that
he was suffering from toothache at a time when he

INTRODUCTION n

visited an orange-grove. Again, the sound of a
particular melody may recall the place where it was
heard. In these cases the association is one of tem-
poral contiguity.

For two objects to be associated in space they must
of course appeal to sight or touch. But when objects
are seen or felt together, they must be seen or felt
simultaneously; therefore spatial association always
involves temporal association. On the other hand,
when two experiences are associated only in time,
one or both must appeal to a non-spatial sense —
such as hearing, smell, or taste, for instance; hence
normal temporal association excludes spatial associa-
tion.1 It follows that there is a double connection
between things seen or felt together, and but a single
connection between conjoined experience of the other
senses.

When sensations follow one another, the associa-
tion is always stronger in the order of the occurrence.
After learning the alphabet forwards, one cannot im-
mediately say it backwards.

The associations in the minds of lower animals are
almost exclusively those of contiguity. The stage-
feats of so-called performing animals are explained
by the associations of certain bodily movements with

1 Sounds and odors can, of course, be thought of as coming from
a particular point in space; but in this case the spatial relation is
expressed in the mind in terms of sight or touch.

12 THE PSYCHOLOGY OF STAMMERING

signals given from behind the scenes. The perform-
ing horse stamps his hoof as the attendant in the wings
waves a flag. He responds merely as an automaton,
and it is needless to say that he knows nothing of
the questions that he is credited with answering.

There is a distinctive form of association that
sunders the human mind from that of the brute; it
is association by similarity. When the round stone
suggests a hammer and the sharp stone an axe,
when a springing branch suggests a bow and the fall-
ing of an apple suggests the mutual attraction of
bodies ; then the human mind supersedes experience.
When a person's associations are those of contiguity,
he must inevitably be a clumsy and laborious thinker.
He plods along, thinking in mental brickbats, and
erecting his thought-structures piece by piece. The
person associating things by similarity holds, as it
were, the magic wand of thought. A bare suggestion,
and the whole superstructure of thought stands
complete : the process seems sufficiently thaumatur-
gic to transcend the laws of association.

Genius, it is held by some psychologists, is identical
with the possession of "similar" association to an
extreme degree. This faculty is accounted sufficient
to explain the achievements of the Newtons and the
Darwins.1

1 There is considerable difference, however, between obeying
similarity and detecting it. Genius is rather the faculty for detect-

INTRODUCTION 13

Contrast, as a cause of association, is but another
phase of similarity. Cause and effect is reducible
to contiguity.

It is beyond question that we are no more able to
ignore association in our thinking than we are able
with our mental images to transcend experience.
One idea is not able to redintegrate any other idea
that we may wish. The ideas that it recalls must
be associated by contiguity or similarity. At best
we can seize upon one of several ideas that present
themselves. Associations do appear that seemingly
violate all these relations; yet the associations un-
doubtedly occur in the fringe of consciousness. There
are in our minds rudimentary and fugitive thoughts
that do not come to the focus of attention. Writing
on obscure associations, James says:1 "If I hear a
friend describe a certain family as having blotting-paper
voices, the image, though immediately felt to be
appropriate, baffles the utmost powers of analysis."
The relation here appears to be hidden in the shadows
of the mind. If one could admit similarity between
the experiences of disparate senses, he would probably

ing it. (See James, "Principles of Psychology," Vol. II, p. 361.)
Efficiency in abstract thought is perhaps due to the ability to attach
the maximum of meaning to a minimum of imagery. The question
then arises as to the nature of meaning, and it may be found that
meaning is as much dependent upon contiguous association as upon
similar association.

1 "Principles of Psychology," Vol. I, p. 582.

14 THE PSYCHOLOGY OF STAMMERING

seek a resemblance between the characteristic quality
of the voices and the soft feeling of blotting-paper.
It seems difficult, however, to believe that there can
be similarity between the experiences of unrelated
senses. It may perhaps be that the resemblance lies
between the sound that results from tearing blotting-
paper, and the sound of the thick and somewhat
husky voices to which the paper is compared. The
association would then be complex, involving both
similarity and temporal contiguity. Many such
associations occur that, for the time being, defy
analysis. Frequently it is only by chance that one
stumbles upon the explanation. There can be little
doubt, however, that a relation of contiguity or simi-
larity invariably exists.

PERCEPTION

Perception is the mental process by which the mind
associates sensations with mental images. The bare
sensation is not an element of knowledge. It is a
mere "that." The percept is a "that which." It is
the sensation, plus its associated images. Bare
sensations, then, do not frequently occur in adult life.
As one inhales the fragrance of a rose, attending merely
to the odor, he experiences something akin to the pure
sensation. But generally things are regarded for
their meaning. One hears a rumble in the distance,
and "perceives" a train. The rumble, however, is

INTRODUCTION 15

a mere auditory sensation. The idea of the train arises
by virtue of association, the sound suggesting the
train's appearance and other qualities. The reader
sees printed words on the page before hiii. The words
are so many black marks upon a white background.
They have meaning only because they are associated
with certain sounds, — the spoken words they rep-
resent. The spoken words, in their turn, are purely
arbitrary symbols. Frequently they have different
meanings in different languages.1 The meaning is
determined entirely by the object, action, etc., that
the word recalls.

The mind in reality contributes the greater part
of the percept. The bare sensation resulting from
the stimulation of the peripheric sense-organ is nothing
more than a cue. As a unitary thing it is devoid of
meaning. The multitudinous associations alone con-
fer meaning upon it. One sees a table top as a square,
though the retinal image is that of a rhombus. A
figure in the distance is perceived as a man, though
one can "cover" him with the little finger. A boy,
a little nearer, produces a retinal image ten times as
large; yet the boy is not mistaken for a giant. It
is the mind's contributions, the associations, that
prevent utter chaos in the interpretation of impres-

1 "The Chilians say papa for 'mother,' and the Georgians say
mama for 'father,' while in various languages dada may mean 'father,'
' cousin,' ' nurse ' ; tata, ' father,' ' son,' ' good-bye ! ' " (Tylor, " Anthro-
pology," p. 129.)

1 6 THE PSYCHOLOGY OF STAMMERING

sions. Common illusions are due to the mind's
contributing the wrong images to a "misinterpreted"
cue. One hears the rustle of leaves, and mistakes
the sound for approaching footsteps; or, seeing a
shadow on the wall, one "perceives" a ghost. The
illusion is due to the fact that an inappropriate image
advances to meet the sensation.

CONCEPTION

A concept is a congeries of associated mental images.
The act of the mind in regarding the relation between
these images, or the relation between different con-
cepts, is called conception. The concept of an apple
may be regarded as the following group of associated
mental images : the visual image of its appearance,
the image of its taste, the image of its smell, the image
derived from handling it, and the verbal image of its
name. There might be still other images, more or
less nascent, — the memory of the sound produced
by paring an apple, and a kinaesthetic image of the
biting action of the jaw, for instance. One particular
image usually forms the nucleus of the concept. In
the present case it would most likely be the visual
image of the fruit, or the verbal image of the word
"apple." The images associated with the nucleus do
not usually come to the foreground of consciousness.
Some of the images may be entirely lacking. A person
born blind would have no visual images in his con-

INTRODUCTION 17

cepts ; a congenitally deaf man would have no images
of sound.

When the concept is of an abstract nature, the
nucleus is usually a verbal image. The nucleus of
a concept used in communication is almost invariably
an arbitrary symbol of this kind, — a spoken or
written word, a word spelled out in the manual
alphabet or in telegraphic code. However, the
symbol contains no innate meaning; its import is
derived solely from the mental images with which
it is associated.

COGNITION, AFFECTION, AND VOLITION

The mental processes are sometimes classified under
the three headings, Cognition, Affection, and Volition;
in other words, knowing, feeling, and willing.

The cognitive processes are those that convey the
elements of knowledge. Such, for instance, are
Sensation, Perception, Conception, Judgment, and
Reasoning. (Judgment and Reasoning are merely
more complex processes of conception and association.)
Affection is the emotional coloring of the cognitive
states. It is the pleasantness or unpleasantness of
a particular experience, — the pleasantness in the
odor of a rose, the unpleasantness in a toothache.
As Angell : puts it, cognition gives the "what";
affection gives the "how." Cognition and affection
1 "Psychology," p. 302.

18 THE PSYCHOLOGY OF STAMMERING

are merely different aspects of the same mental
states.1

For the present discussion the will may be regarded
subjectively as the decision to act. Objectively, it
is the biological property of "irritability"; i.e. the
tendency of all living matter to express a sensory
stimulus in a motor response.2 The subject will be
considered a little more fully in a later chapter.

THE NATURE OF THOUGHT

Words are by no means essential to thought. The
whole breadth of the stream of consciousness may
be engaged by a series of sensations and perceptions.
One may walk through the country, drinking in the
sights and sounds, with never a verbal thought in
one's mind. For conception, too, one may dispense
with words entirely. In playing chess, solving prob-
lems in geometry, designing bridges and machinery,
visual images alone are necessary. In composing
music, auditory images suffice ; verbal images would
be an encumbrance.

Meeting a person in the street, one may think to
himself, "I wonder if that man is the actor I saw per-
forming last evening ; " yet not a single word need be
contained in the idea. The visual impression arouses

1 As will be explained in Chapter IX, the emotions are, in their
last analysis, organic sensations in which affection is at a maximum
and cognition at a minimum.

2 This is the law of dynamogenesis.

INTRODUCTION 19

the image of the actor as he was seen upon the stage,
and the relationship of identity presents itself to the
mind in some recondite manner that is no less in-
scrutable than consciousness itself. Again, the visual
imagery may "reply," "No, this man is too tall, and
too stout." No words would be necessary unless
the thought were to be communicated to another
person. In this case the words would not be under-
stood unless — as purely arbitrary symbols — they
aroused the appropriate visual images in the mind
of the auditor. The whole thought-process might
well occur in the mind of a deaf and dumb man that
had never heard or spoken a word in the course of his
existence. The thought may, of course, be accom-
panied or followed by verbal images, but in this case
the words are visually initiated, just as they are visu-
ally interpreted by the person that hears them
spoken.

To take another instance: — A man stands upon
the doorstep surveying the sky; then decides to
reenter the house for his umbrella. The thought-
process is probably as follows : The black clouds
conjure up in the man's mind visual images of falling
rain (or he may have tactual images of raindrops
striking his cheeks). He then visualizes himself
in the act of holding up an umbrella. This image im-
mediately redintegrates another visual image of the
umbrella standing in a particular part of the house,

20 THE PSYCHOLOGY OF STAMMERING

and he thereupon decides to fetch it.1 There might
arise in his mind the words, " I must get my umbrella" ;
but if they appear, they do so after the decision to act,
- that is, when the thought-process is complete.
The words have no intrinsic part in the thought;
they are purely epiphenomenal. If, by sheer asso-
ciation, the clouds could arouse the verbal thought,
"It is going to rain," the words would still mean
nothing without their visual associates. If this
thought were followed by the words, "I must get my
umbrella," the man would still be no farther forward
if there were lacking concrete images of his umbrella
and the place where it stood. He would be in the
position of a parrot that echoes words without under-
standing them.

Words, then, are not indispensable to thought.
A congenitally deaf person that has not mastered
language can carry on an intelligent conversation
in demonstrative and imitative gesture. A person
may lose all memory of words (a pathological con-
dition known as amnesia verbalis, or verbal amnesia),
and yet maintain a high order of intelligence.
This is accounted for by the fact that much of our
ordinary thought proceeds in visual, auditory, and
kinaesthetic imagery. Concrete objects are thought

1 We might introduce kinaesthetic images at this point. As the
subject of voluntary muscular movements has not yet been fully
discussed, the kinaesthetic images are omitted.

INTRODUCTION 21

of in visual terms, and their names may be totally
ignored.1

Abstract thought, as well as concrete thought, may
proceed in non-verbal imagery. The writer finds
that much of his abstract thought is conducted in
visual and motor terms, the motor images being
frequently those of eye-movements. Considered with
reference to their content, the images are meagre and
rudimental; considered in regard to their function,
they are frequently more cogent than elaborate col-
locations of verbal images. The writer was recently
listening to a discussion concerning a parabola, in
which the explanation was somewhat desultory. A
visual image of a parabola was in the mind. During
the discourse the method of handling the subject was
suddenly criticized — as it were, in an undercurrent
of consciousness — by a thought whose content was
nothing more than a mental glance across the arms of
the parabola, and then around its contour. The
following verbal interpretation of the thought was
written within three minutes of the occurrence of
the incident : "A person that is not a logical thinker
is apt to proceed on the assumption that his auditor's
mental imagery is identical with his own. He dis-
cusses particular details simply and solely because
some point in his imagery happens to attract his

1 Consequently the names of concrete objects are often forgotten
first in old age.

22 THE PSYCHOLOGY OF STAMMERING

attention; for this reason the method of procedure
is entirely adventitious. The methodical thinker, on
the other hand, first examines his mental imagery
and assures himself that it is adequate to the discus-
sion; then he builds up, piece by piece, the same
imagery in the mind of the hearer. This done, they
talk to an identical purpose." The glance across the
parabola symbolized the desultory thought. The
glance around its contour represented the methodical
procedure. The two processes were mentally con-
trasted. As an interpolation, the thought would have
been too involved to find expression in words, for the
attention deviated scarcely a moment from the words
of the speaker.

Much of one's thinking is, however, conducted in
verbal imagery. Language originated as a means
of communication ; l but it has become an instrument
of thought for the reason that words have become
nuclei of concepts. As concepts grow more abstract

1 The earliest linguistic efforts are supposed to have been imita-
tive emotional cries. "When English woe is traced back to Anglo-
Saxon wa, it is found to be an actual groan turned (like the German
•weh) into a substantive expressing sorrow or distress." (Tylor,
''Anthropology," p. 126.) A further advance in evolution would be
represented by the addition of onomatopoetic, or imitative, words.
Such, for instance, are the words buzz, hum, clatter, ding-dong, pewit,
mew, etc. Words of this kind would soon lose all trace of their
origin. This can be readily understood when one notices the great
dissimilarity between English and German words that were once
identical.

INTRODUCTION 23

and general, the representation becomes more largely
verbal, and less and less visual. Ideas of integrity,
thrifttessness, incompatibility, plasticity, speed, etc., are
with many people almost purely verbal in their rep-
resentation. Consequently these people find mental
language indispensable for abstract thought ; though
their concrete ideas may be portrayed in other forms
of imagery. Many people are greatly reduced in
intelligence when suffering from verbal amnesia.

It is by no means essential, however, that the ab-
stract concept be built up around the spoken word.
The nucleus may just as well be a graphic representa-
tion, — a diagram, an Egyptian hieroglyph, a con-
ventional scriptory symbol. In the case of deaf-
mutes it may be a gesture, or a sign in the manual
alphabet, — mentally represented in visual or motor
terms. With the blind, the nucleus of a concept may
be a tactile image of raised print. In the case of
the deaf-blind it may be a word tapped out (by the
Braille system) into the palm of the hand. The
imagery may be in either kinaesthetic or tactile terms,
- the subject imagines himself tapping the words into
the palm of another person, or imagines the words
being tapped into his own hand.

The concept-nucleus is, then, often entirely arbi-
trary. It makes no difference whether a horse is
called horse, pferd, or cheval. It makes no difference
whether the word integrity is heard as sound, is seen

24 THE PSYCHOLOGY OF STAMMERING

as marks on paper, or is felt as somebody's
finger-movements in one's hand. The meaning of
these symbols inheres in the congeries of associated
mental images that are either overtly or nascently
aroused.

CHAPTER II

MENTAL TYPES: EYE-MINDEDNESS, EAR-MINDED-
NESS, ETC.

As Ribot has appropriately remarked, we have
memories rather than memory. We have, as it were,
a number of separate and individual minds, — an
auditory mind, a visual mind, a kinaesthetic mind, a
tactile mind, and so on. These minds may be con-
jointly or separately active. One may think simply
of the appearance of a rose, or he may think simul-
taneously of its appearance, its fragrance, and the
softness of its petals.

One or more of these minds may be entirely lacking.
A blind person has no images of sight ; a deaf person,
no images of hearing. The deaf-blind have images
for neither of these senses. A child that becomes
blind before the age of six or seven loses his visual
memory. Similarly, a child becoming deaf loses all
imagery of sounds. In the case of Laura Bridgman
- who, as a child, suffered loss of the senses of sight,
hearing, taste, and smell — the world of sensation
and memory would be almost exclusively tactile and
kinaesthetic. There must, then, be considerable
difference in the workings of individual minds.

25

26 THE PSYCHOLOGY OF STAMMERING

"Sounds certainly play a far more prominent part in the
mental life of the blind than in our own. In taking a walk
through the country, the mutations of sound, far and near,
constitute their chief delight. And to a great extent their
imagination of distance and of objects moving from one distant
spot to another seems to consist in thinking how a certain
sonority would be modified by the change of place." l

A congenitally deaf person could have no such ex-
perience. For him, sensations and memory of hear-
ing have no existence. He sees things, and remembers
their appearance. The blind man hears them, and
retains the memory of their sound. Each is able to
think in terms that the other is totally unable to
comprehend.

A person possessed of all the different senses is
able to experience sensations of every type. It does
not follow, however, that he can think equally well
in all types of mental imagery. The different mem-
ories are not equally developed. Most people are
practically devoid of imagery for taste and smell;
some have little memory for sights and sounds. In
remembering the ocean, one man sees the waves as
they break upon the shore; another hears them;
a third may feel the damp spray as it is blown into
his face; and still a fourth may smell seaweed and
brine. One man is eye-minded, thinking in terms of
sight; another is ear-minded, thinking in terms of
sound; still another is motor-minded, thinking in

1 James, "Principles of Psychology," Vol. II, p. 205.

MENTAL TYPES 27

terms of muscular movements. The eye-minded man
is called a visile, visnel, or visionaire; the ear-minded
man, an audile, auditeur, or auditaire; the motor-
minded man is a motile, moteur, or motaire. There is
also a type called the tactile. This type is found
perhaps almost exclusively among the blind. The
person of the mixed type, the indifferent, thinks equally
well in any form of mental imagery.

The visile remembers best that which he sees;
the audile, that which he hears ; and the motile or
tactile, that which he feels. Actors have different
ways of learning their parts. One reads his part
from the printed page, and learns through the visual
imagery ; another has the part read aloud to him, and
relies upon his acoustic memory ; still a third writes
his part, and depends upon his visual and motor
memories ; or he may read the part aloud, and recall
the words by their sound and feeling. To test the
spelling of a word, one man mentally repeats the let-
ters or utters them aloud. He judges of the accuracy
by sound. Another must see the word in writing, or
must "picture " the written word before him. A third
executes the writing movements before he is sure of
the spelling. After a tedious train journey the visile
sees the different incidents of his tiresome ride; the
audile hears the clangor and rumble of the train;
and for hours the motile may feel its swaying.1

last memory is, strictly speaking, not in kinaesthetic

28 THE PSYCHOLOGY OF STAMMERING

The different image-types are not mutually ex-
clusive. The visile does not think solely in visual
imagery; his visual imagery merely predominates.
In some cases, however, the thought-processes are
conducted almost exclusively in the predominant
form of mental imagery.

Not only is the prevalent image-type different with
different persons, but in persons with the same type
of mind the prevalent images may differ in intensity.
Of two visiles, one will have optical images that differ
little from sensations of sight, the other will have
images that are rudimentary and schematic. In some
cases the images are highly colored; in others, they
appear only in light and shade. In the same person
the mental imagery may vary greatly with the physical
condition. Frequently the visual imagery becomes
intense and highly colored during physical or mental
fatigue. The perspicuity of visual imagery in iso-
lated cases is demonstrated by feats of blindfold
chess-playing. Some experts will, when blindfolded,
conduct as many as sixteen or twenty games simul-
taneously, and win a majority of them. Each board,
with the position of its men, must be clearly visual-
ized ; and as the player goes from board to board,
he must remember the groupings of the pieces as he

terms. The images are of static sensations, — sensations derived
from movements of the whole body rather than of parts of it.
These particular images seem to be particularly strong, however, in
some motiles.

MENTAL TYPES 29

left them. A couple of such experts can conduct
an imaginary game as they walk upon the street.
Some artists find their visual images so distinct that
they can dispense with their models after a single
sitting.1 Vivid mental images frequently border
upon hallucinations. Galton says :

"A well-known frequenter of the Royal Institution tells me
that he often craves for an absence of visual perceptions [images],
they are so brilliant and persistent." 2

Galton conducted systematic inquiries into dif-
ferences in mental imagery. He requested his sub-
jects to describe, among other things, their memory of
the breakfast table. This question has now become
classical. The two following reports, taken "from
returns, furnished by 100 men, at least half of whom
are distinguished in science or in other fields of intel-
lectual work," illustrate the extremes of brilliancy and
obscurity in visual imagery :

"'Thinking of my breakfast table this morning, all the ob-
jects in my mental picture are as bright as the actual scene.1" *

The second report runs :

" ' My powers are zero. To my consciousness there is almost
no association of memory with objective visual impressions. I
recollect the breakfast table, but do not see it. " ' 4

1 See Ballet, "Le langage interieur et 1'aphasie," 2ded., pp. 36-37.
1 " Inquiries into Human Faculty and its Development," p. 97.
1 Loc. cit., p. 89. 4 Loc. cit., p. 92.

30 THE PSYCHOLOGY OF STAMMERING

James quotes the following introspective descrip-
tions by two of his psychology students : 1

"'This morning's breakfast table is both dim and bright ; it
is dim if I try to think of it when my eyes are open upon any
object ; it is perfectly clear and bright if I think of it with my
eyes closed. All the objects are clear at once, yet when I con-
fine my attention to any one object it becomes far more distinct.
— I have more power to recall color than any other one thing :
if, for example, I were to recall a plate decorated with flowers,
I could reproduce in a drawing the exact tone, etc. The color
of anything that was on the table is perfectly vivid. — There is
very little limitation to the extent of my images : I can see all
four sides of a room, I can see all four sides of two, three, four,
even more rooms with such distinctness that if you should ask
me what was in any particular place in any one, or ask me to
count the chairs, etc., I could do it without the least hesitation. —
The more I learn by heart the more clearly do I see images of
my pages. Even before I can recite the lines I see them so that
I could give them very slowly word for word, but my mind is so
occupied in looking at my printed image that I have no idea
of what I am saying, of the sense of it, etc. When I first found
myself doing this I used to think it was merely because I knew
the lines imperfectly ; but I have quite convinced myself that
I really do see an image. The strongest proof that such is
really that fact is, I think, the following :

"'I can look down the mentally seen page and see the words
that commence all the lines, and from any one of these words I
can continue the line. I find this much easier to do if the words
begin in a straight line than if there are breaks.'"

The second description gives the other extreme in
visual imagery:

1 "Principles of Psychology," Vol. II, pp. 56 f.

MENTAL TYPES 31

'"My ability to form mental images seems, from what I
have studied of other people's images, to be defective, and
somewhat peculiar. The process by which I seem to remember
any particular event is not by a series of distinct images, but a
sort of panorama, the faintest impressions of which are per-
ceptible through a thick fog. — I cannot shut my eyes and get a
distinct image of anyone, although I used to be able to a few
years ago, and the faculty seems to have gradually slipped
away. — In my most vivid dreams, where the events appear
like the most real facts, I am often troubled with a dimness of
sight which causes the images to appear indistinct. — To
come to the question of the breakfast table, there is nothing
definite about it. Everything is vague. I cannot say what I see.
I could not possibly count the chairs, but I happen to know that
there are ten. I see nothing in detail. — The chief thing is a
general impression that I cannot tell exactly what I do see.
The coloring is about the same, as far as I can recall it, only very
much washed out. Perhaps the only color I can see at all dis-
tinctly is that of the table-cloth, and I could probably see the
color of the wall-paper if I could remember what color it was.' " '

The following account, from another source, shows
strong auditory and tactile imagery : 2

"'In recalling a fire which I witnessed I can hear the church
bells ringing out the alarm, and can plainly distinguish between
the deep tones of one and the higher pitch of the other. All the
confusion of sounds now comes to me — the shouting from dif-
ferent quarters of the town, the sound of footsteps on the board
sidewalks, even the sound of my own breathing and puffing
and of those running by my side. I have no really distinct

1 James, loc. cit., p. 57.

1 Scott, "Psychology of Public Speaking," pp. 26 f.

32 THE PSYCHOLOGY OF STAMMERING

vision of the fire itself, but can hear the cracking of breaking
glass, the peculiar roar of a huge blaze, and the excited voices
of the crowd. The picture is one of confusion, and noise pre-
dominates. I can easily see in imagination the faces of my
acquaintances, but it is easier to hear their voices. In playing
accompaniments to mandolin pieces upon a guitar, I derive
almost the same amount of pleasure whether the other instru-
ments are present or not. My imagination supplies all the
absent parts. I can accompany and hear an air which is too
difficult for me to render on a piano or by whistling; in my
imagination every note is vivid. As for images of touch, they
are most vivid to me when I hear or listen to accounts of sur-
gical operations. If such accounts refer to a broken leg, there
is a painful sensation in that part of my anatomy, and I fear to
step with that leg lest I hurt it. If I see a fly crawling on
any one, I have an intense desire to brush it off, and feel re-
lieved if I rub my face vigorously in the corresponding part.' "

The next report (a reply to definite questions) shows
extremely weak acoustic imagery : l

'"I am not able to state whether I hear the train or not. I
am inclined to think that it is a noiseless one. It is hard for me
to conceive the sound of a bell, for instance. I can see the bell
move to and fro, and for an instant seem to hear the ding-dong,
but it is gone before I can identify it. When I try to conceive
of shouts, I am like one groping in the dark. I cannot possibly
retain the conception of a sound for any length of time.'"

Wilfred Lay describes his own auditory imagery
in the following terms : 2

1 Scott, loc. cit., p. 24.

'"Mental Imagery," Psychological Review, Monograph Supple-
ment No. 7, p. 36.

MENTAL TYPES 33

"I find the auditory mental imagery in my case to be almost
as important a factor in my mental life as is the visual, being
a mental reproduction of the sounds I have heard — musical
or otherwise. They are comparable with real sounds not so
much in intensity, but perfectly with timbre, pitch, and dura-
tion. I can estimate a minute with much greater exactness
mentally, if I listen to the auditory mental imagery of a piece
of music which takes about a minute to perform."

The present writer can report the converse in
auditory imagery. Apart from an auditory-motor
memory for words (in which the auditory element is
signally weak) he has no memory for sound what-
ever.

The motor memory has been a good deal neglected
by psychologists, — probably because vivid motor
imagery is somewhat rare, and fugitive images are
difficult to introspect. The subjoined account gives
a description of clear motor memory : l

" ' My mental imagery seems to be of the motile type, strongly
characterized by a sense of position and direction. My visual
images are poor. I can only obtain the visual image of a
familiar face by successively giving my attention to the separate
features; the whole face does not appear to my mind. A
word is indelibly fixed in my mind if I trace its characters on
the palm of my left hand with the forefinger of my right. The
mention of an author or a book brings up the position which
that work occupies on the shelves with which I am familiar,
but does not call up the looks of the surroundings. The idea
of the cardinal points of the compass never leaves me, though

1 Scott, "The Psychology of Public Speaking," p. 25.

34 THE PSYCHOLOGY OF STAMMERING

it is frequently a mistaken one. In the city of Chicago my
only guide is this sense of direction, which seldom leads me
astray. I doubt my ability to locate by streets or by adjacent
structures, the buildings with which I am most familiar. Words
representing things that I have seen always give me a sense of
their direction and position. Other words are invariably as-
sociated with the feeling of articulating them. In the act of
writing, each letter is mentally pronounced. Among my early
memories is one of firing a revolver. I remember pulling the
trigger, but not the report that followed.'"

Galton mentions the circumstance of a young
Indian's following the outline of a drawing in the
Illustrated News with the point of his knife, in order,
as he explained, that he might "remember the better
how to carve it when he returned home." * Obvi-
ously he was resorting to his motor memory.

The motor memory appears to be weak in the
majority of persons. Bastian, in the following
lines, attests the feebleness of his own kinsesthetic
imagery :

"Let him [the reader] close his eyes, and with pen in hand
make movements in the air as though he were writing the word
'London.' He may thus assure himself that he has a set of
sensations accompanying these movements. After an interval,
say the next day, let him again close his eyes, and, without
making any movement, attempt to recall 'in idea' the muscular
and other sensations he previously experienced when writing
the above-mentioned word. Let him then contrast his com-
parative powerlessness in this direction, with his ability to recall

1 "Inquiries into Human Faculty and Its Development," p. 97.

MENTAL TYPES 35

in idea the visual appearance of this word when written or its
corresponding sound." l

The comparative powerlessness to recall kin aes-
thetic impressions has no existence for the motile.
The present writer, whose motor images are ex-
tremely vivid, can recall these movements with the
utmost facility, but he finds it difficult to recall
the visual or auditory image. The writer well re-
members that, long before he knew anything of
mental imagery, he would practise pieces on the
piano by performing the more difficult passages in
kinaesthetic imagery of finger-movements. He could
play from memory ; though this memory was purely
visual and motor, the auditory musical imagery
being non-existent. The writer takes an amateur's
interest in card tricks. Recently he was acquir-
ing some new sleights of hand, and frequently prac-
tised them in motor imagery while walking in the
street.

Sufficient has been said to show that there is a great
diversity in individual minds ; that human minds are,
in fact, as different as human faces. There is a dif-
ference both in the type of imagery employed, and
in the intensity of the imagery itself. With some
persons a particular form of memory may never de-
velop: there is congenital amnesia. Olfactory and
gustatory amnesia are too common to be abnormal
1 "Aphasia and Other Speech Defects," p. 10.

36 THE PSYCHOLOGY OF STAMMERING

Musical amnesia, too, occurs with the greatest fre-
quency. It is recognized as the lack of a "musical
ear." Auditory amnesia (for the more ordinary
physical sounds) is congenital in many persons.
Visual amnesia is more rare, but, as James says,
"some people undoubtedly have no visual images
at all worthy of the name."

As regards the difference in intensity, Galton has
established the fact that men of science, or, in general,
men eminent in the field of intellectual work, are
strikingly deficient in visualizing powers. — Vivid
mental pictures would be likely to divert the attention
in abstract thought. These images probably be-
come vestigial because the thinker attends to the
relations between them, and ceases to regard them
for their content. To a considerable extent visual
images are supplanted by verbal thought. — Galton
further ascertained that "the power of visualizing is
higher in the female sex than in the male," and that
it is stronger in children than in adults.

More extensive inquiries would probably have
elicited the fact that auditory imagery is more prom-
inent in females. There appears no a priori reason
why the greater intensity should be limited to one
particular class of mental imagery. There seems to
be a correlation, as regards intensity, between the
different forms of mental imagery. From inquiries
among 125 artists and sculptors (who must per-

MENTAL TYPES 37

force have strong visual imagery) Lay found that
92 per cent could recall music with sufficient clear-
ness to derive pleasure from the imagery. Sixty-
eight per cent derived pleasure from the memory
of fruit — presumably from the gustative memory.
These percentages are sufficiently high to suggest
the correlation mentioned. The greater clearness
of the mental imagery in the female sex would readily
account for woman's greater conversableness, the
more intense verbal imagery finding a more ready
expression in articulate speech. The same phe-
nomenon would account for the earlier acquisition
of speech by girls.

The clearness of mental imagery is by no means
correlated with the keeness of sense-perception. A
person may have little visual memory, but still be
quick to recognize faces. He may have no memory
for colors, but may be able to distinguish the finest
differences of shade. He may be devoid of auditory
imagery, and yet readily recognize voices. He may
possess not a vestige of musical memory, and yet have
a keen appreciation for music. Furthermore, there
is no essential connection between the imagery of the
waking state and the imagery of dreams. One may
be ordinarily destitute of auditory imagery, and yet
dream in terms of sound. During illness, such a per-
son may have hallucinations or pseudo-hallucina-
tions of hearing.

38 THE PSYCHOLOGY OF STAMMERING

Among the curiosities of mind are certain bizarre
associations of mental imagery. This associational
process is known as syn&sthesia. Many people,
when listening to music, associate the tones with
mental images of color. Thus a veritable kaleido-
scopic performance goes on in the mind. This
particular form of association is known as color-
audition, or chromasthesia. Other people associate
colors with tastes. Yellow may be salt; green,
acid ; red, peppery ; etc.

Many persons employ mnemonic devices, known as
number-forms, in recalling numerals, days of the week,
months of the year, etc. When they think of a date
or hear one mentioned, they immediately associate
it with its particular position on a "visual" calendar.
Hours of the day are associated with the position
of the hands on a "visual" timepiece. These as-
sociations are invariable in the same person, but
are seldom alike in two different people. They occur
more frequently in females than in males, and are
more common among children than among adults.
Usually they have existed too far back for the memory
to determine their origin.

" Traces of the origin of the Forms that appear here and there
are dominoes, cards, counters, an abacus, the fingers, counting
by coins, feet and inches (a yellow carpenter's rule appears in
one case with 56 in large figures upon it), the country surround-
ing the child's home, with its hills and dales, objects in the gar-
den (one scientific man sees the old garden walk, and the nu-

MENTAL TYPES 39

meral 7 at the tub sunk in the ground where his father filled his
watering pot). Some associations seem connected with the
objects spoken of in the doggerel verses by which children are
often taught their numbers." l

In his "Inquiries into Human Faculty" Galton
gives nearly seventy illustrations — many of them
in colors — representing different mnemonic devices.
The following is one of the descriptions showing
associations between numerals and colors : 2

" ' Up to 30 I see the numbers in clear white ; to 40 in gray ;
40-50 in flaming orange ; 50-60 in green ; 60-70 in dark blue ; 70
I am not sure about ; 80 is reddish, I think ; and 90 is yellow ;
but these latter divisions are very indistinct in my mind's eye.'"

In another case the numerals from i to 9 appear
in different colors : i is black ; 2, yellow ; 3, pale
brick-red; 4, brown; 5, blackish gray; 6, reddish
brown; 7, green; 8, bluish; 9, reddish brown,
"somewhat like 6." The colors are very distinct
when the numbers occur separately. In compounds
they are less clear. For historical dates the num-
bers appear upon a colored background that resembles
the particular hue of the principal figure indicating
the century.

In many cases the letters of the alphabet, par-
ticularly the vowels, are invested with color. This
subject will recur in the final chapter.

1 Gallon, "Inquiries into Human Faculty and Its Development,"
p. 128. *Loc. cit., p. 141.

CHAPTER III

THE VERBAL IMAGE

A LANGUAGE is any system of symbols used pri-
marily for the expression of thought. The symbol
is the nucleus of a concept. When used as a means of
communication, it is intended to make known — by
means of its associations — the thought passing in
the mind of the person employing it. Language is
not necessarily speech. We have a written language,
a language of gestures, a manual language, and so on.
Had we lived in a world with no enveloping atmos-
phere, it would have been impossible for the evolving
race to communicate by means of acoustic symbols;
that is, by vocal speech. With no air to convey
sound-waves, there would have been no sense of
hearing. For communication, the race must per-
force have resorted to the only other distance-receptor
available, — the sense of sight. There would then
have developed a complex language of gestures, or
perhaps a manual or a labial language. Sight and
feeling would be the only two senses involved.

It has been shown in Chapter I that the concept-
nucleus may be almost any mental image whatever.

40

THE VERBAL IMAGE 41

With the deaf-mute, the nucleus may be a visual
or kinaesthetic image of certain finger-movements.
With the deaf-blind, the language-concept is still
further limited ; it is a tactual or motor representa-
tion of finger-movements. These cases are admittedly
exceptional. They are cited to emphasize the fact
that language is not necessarily represented in the
mind by auditory memory-images of spoken words.

In this chapter, spoken language will be the chief
subject of consideration. Spoken language does not,
however, involve merely the sense of hearing. Words
are distinctly felt as they are uttered : the movements
of the lips, tongue, and larynx are as much a part of
the verbal concept as are the sounds that these move-
ments produce. Further, these oral movements can
be seen. Lip-reading becomes an accomplishment
among the deaf, and for the interpretation of speech
the sense of sight serves them almost as well as would
the sense of hearing. Spoken language, then, may in-
volve the three senses of hearing, feeling,1 and vision ;
and the mental representation may be in terms of
mental images pertaining to any one of these senses.
In normal cases, vision naturally plays no conspicuous
part.

The matter becomes slightly more complex when
written language is considered in addition to spoken
language. In the act of writing, both kinaesthetic

1 Accepting feeling for the time being as a unitary sense.

42 THE PSYCHOLOGY OF STAMMERING

and visual sensations are present. In the act of read-
ing, vision alone is involved.

From the above discussion it is evident that the
verbal image may be represented in any one of a
variety of elemental forms, or that it may subsist
in the mind as a complex of several elementary images.
With the educated person there is, in addition to
the auditory and kinaesthetic images of the spoken
word (with occasionally a visual representation),
a visual and a motor image of the written symbol.
It was shown in Chapter II that different types of
images are present in different minds with varying
degrees of prominence. Thus it is naturally to be
expected that there should exist different types of
verbal thought with different persons, — that the
audile should think of the sound of the word, the
motile of its feeling, and the visile chiefly of its graphic
representation. It is seldom, of course, that one type
of imagery prevails to the exclusion of all others.
In the audile, hearing predominates ; in the articulo-
moteur, the memory of feeling is preponderant; in
the audito-moteur, the two elements may be equally
conspicuous.

People of the visual verbal type are rather rare, yet —

"Some few persons see mentally in print every word that
is uttered ; they attend to the visual equivalent and not to the
sound of the words, and they read them off usually as from a
long imaginary strip of paper, such as is unwound from tele-

THE VERBAL IMAGE 43

graph instruments. The experiences differ in detail as to size
and kind of type, color of paper, and so forth, but are always
the same in the same person." l

These visual images appear also in silent thought,
but they are more in evidence when the subject is
speaking, or is listening to the words of another person.
Frequently the words appearing before the mind are
written instead of printed.

In silent thought the words are, as a rule, mentally
pronounced. But this is not invariably the case ;
sometimes the appreciation of the word is purely
visual. One may read printed words in much the
same way as he would read Indian picture-writing
or Egyptian hieroglyphics; i.e. without necessarily
having recourse to spoken words or their memory-
images. The reading of a foreign language is often
largely visual where knowledge of it happens to be
deficient ; though the average person would, of course,
improvise a pronunciation that would serve all the
purposes of the most exact verbal imagery. In read-
ing numbers or foreign names, the appreciation is
often entirely visual. Few persons would stop to
bestow more than a schematic pronunciation upon
such a word as Nizhn-Udinsk. Still fewer would
accord the full titulary dignity to such a number as
6,328,087,628,041 ; its value — like that of a number

1 Gallon, "Inquiries into Human Faculty and Its Development,"
p. 97.

44 - THE PSYCHOLOGY OF STAMMERING

expressed in Roman numerals — would be under-
stood in a general way without being interpreted in
words. Similarly the visile understands his mental
words without pronouncing them. He thinks much
as the deaf-mute reads; that is, by associating the
printed word directly with the images that give it
meaning. But, as already stated, the visile usually
pronounces his words mentally after they have
appeared in the visual form. The process merely
starts with the visual image, and is consummated
when the word is mentally heard or spoken.

In exceptional cases words may present themselves
to the visile as optical images of articulative move-
ments. This type of verbal memory is present to
an extent among the congenitally deaf that have
learned oral speech by sight and feeling. The visual
images, however, are accompanied by memories of
feeling, which undoubtedly play a prominent part
in verbal thought.

The mental hearing or mental pronouncing of a
word represents the most common type of verbal
imagery. The average person would testify without
a moment's hesitation that, when he thinks in words,
he hears the words in his mind. In most cases the
statement would be true; but in most cases, too, it
would represent but a part of the truth. The average
person feels his words just as much as he hears them.
His verbal image is a complex. This is especially

THE VERBAL IMAGE 45

true when verbal thought is about to find expression
in speech. It will be best to treat the matter sys-
tematically and to show: first, that the verbal
imagery may in some cases be purely auditory;
secondly, that in others it may be purely kinaesthetic ;
and thirdly, that with most persons it is composite,
being both kinaesthetic and auditory.

To begin with the pure auditory image : As there
exists an auditory memory for music and the com-
moner physical sounds, so there exists a purely
auditory memory for spoken words. The evidence
in support of this fact is conclusive. An audile will
occasionally hear a number of voices simultaneously.
Manifestly, such verbal imagery could not subsist
in kinaesthetic terms : it is heard ; it could not pos-
sibly be felt. Occasionally the subject imagines that
he is himself speaking in concert with a number of
other people. In this case his own speech may be
kinaesthetically represented, but the speech of the
other persons must be purely auditory. The writer
recently had an experience of this kind during a dream.
He was listening to the excellent singing of a chorus
of about thirty voices. Occasionally his own voice
would intrude, much to the detriment of the melody.
The singing of the chorus was purely auditory ; l
the voice of the writer was auditory-motor.

1 With the writer, no such auditory imagery appears during the
waking state.

46 THE PSYCHOLOGY OF STAMMERING

As further evidence that verbal imagery may be
purely auditory, we have the testimony of some
psychologists that they hear their words when they
think. Egger says,1 "My internal utterance is an
imitation of my voice." In another passage he com-
pares mental language to an echo. Bastian2 finds
that his verbal imagery is chiefly auditory, and that
the kinaesthetic images of words are scarcely recover-
able. Titchener 3 quotes the following introspective
description of auditory verbal imagery: "'The R
seemed to ring through my head. Letters came by
sound; I did not speak them.'" Many people have
auditory images of words during the primary memory.
As they listen to the after-sensation, or mental-echo,
of words they have just heard pronounced, they hear
them "ringing in the head."

As further evidence that verbal memory is often in
acoustic terms, we have the fact that many people
lose all memory of words when that brain-centre is
destroyed in which auditory memory resides.4

And now for the kinaesthetic imagery. What proof
have we of its importance? It has sometimes been
argued that, since the deaf child remains dumb be-
cause of lack of hearing, the auditory imagery must

1 "La parole inte'rieure," 2d ed., p. 67.

'"Aphasia and Other Speech Defects" and "The Brain as
an Organ of Mind."

1 " Experimental Psychology," Part II, Vol. I, p. 399.

4 The subject of brain-centres will be discussed in the next chapter.

THE VERBAL IMAGE 47

necessarily be the most important element in verbal
thought. The argument is fallacious. Even the
person possessed of hearing may have practically
no secondary auditory memory, — yet he thinks in
words and speaks with perfect fluency. During the
learning-process, in such cases, the child uses his
kinaesthetic and primary auditory memories; or he
may use hearing merely as a guide, learning chiefly
by feeling and correcting himself by ear. In either
case the words are remembered in terms of feeling;
that is, in kinaesthetic imagery.

The child that is born deaf would never learn to
speak, or think in words, if internal language were
entirely dependent upon auditory memory. How-
ever, the child is taught to speak with considerable
fluency by using sight and feeling as guides. The
words are then remembered largely in terms of
feeling. Educated deaf people learn to speak with
such fluency, and to read the lips of other speakers
with such readiness, that in many cases their con-
versation gives no evidence of their infirmity. In the
following words Kussmaul describes a conversation
he had with a deaf person that Had been orally
taught : l

"One day I was engaged in conversation in the hospital
for a considerable time with an intelligent young bookbinder,
who was suffering from phthisis, without noticing anything

1 "Storungen der Sprache," 4th ed., p. 54.

48 THE PSYCHOLOGY OF STAMMERING

abnormal in his speech except a Icrud voice and an unusually
measured and careful utterance. It was not till I had finished
the examination and taken my report of the case, that I learned
to my astonishment that I had before me a person that was
absolutely deaf." 1

In such cases as this, words are remembered in
visual and kinaesthetic terms. There may be visual
images of the movements of the lips and tongue ; but
the action of the larynx, pharynx, soft palate, etc.,
must in memory be "felt." These organs cannot
well be observed during speech; hence their action
cannot be visually remembered. Visual images are
not even necessary. Sight may be used merely as
a guide during the learning-process, and the words
may be retained only in terms of feeling. Helen
Keller, who was both blind and deaf, managed to
master speech solely by the sense of feeling. It is
evident that her words must be retained solely as
kinaesthetic images.2

1 The speech of the educated deaf is usually lacking in proper
accentuation and inflection, — elements of speech that are not
readily felt. There is a somewhat impartial distribution of stress ;
thus the enunciation comes to resemble that of French, in which
articulation is vigorous and stress inconspicuous.

2 Miss Helen Keller was deprived of sight and hearing at the
age of nineteen months. Some years later she was taught to speak
"by feeling." In spite of her disabilities she managed to acquire a
thorough education. She graduated from Radcliffe College with
the degree of Bachelor of Arts in 1904. Miss Keller has on several
occasions spoken from the public platform. See her "Story of my
Life," New York, 1908.

THE VERBAL IMAGE 49

Among normal persons, the motile may remember
his words almost exclusively in terms of feeling. If he
happens to be deficient in auditory and visual memory,
there is no other way in which he can remember them.
Speaking of his mental words, Dodge says : 1

"I spoke them. . They were rudimentary, and for the most
part indistinct."

And again : 2

"It is just as though I spoke the words — except for the
fact that the acoustic element is lacking. Often there are
actual movements of the lips and tongue. More frequently
I am uncertain whether these have taken place. In no case
were visual images or images of writing-movements detected.
Acoustic images were just as little in evidence. The words
had neither timbre, pitch, nor acoustic intensity. However,
they were not mere skeleton- words, such as pure movement-
images would represent; they possessed on the contrary a
certain fulness that distinguished them in a characteristic
manner from other memory-images of simple mouth-move-
ments."

On a later page he says : 3

"I am able to imagine quite clearly the movements that I
make in producing certain sounds, and I can analyze their
separate elements. Nevertheless, what is analyzed is cer-
tainly not auditory imagery."

His verbal thought is not represented by visual
images of printed words, for according to the author's

1 "Die Motorischen Wortvorstellungen," p. 10.
* Loc. cit., pp. ii-i2. * Loc. cit., p. 34.

50 THE PSYCHOLOGY OF STAMMERING

account his visual images are inadequate for this
purpose :

"It is easy for me to command clear optical images of printed
or written letters. I can even visualize small groups of letters,
or short words. This faculty for visualizing with uniform clear-
ness ceases with words of four or five letters. I cannot always
picture four letters at once with uniform distinctness. When
the words are longer, I get a general picture — more or less
distinct — in which the letters become clear in quick succes-
sion. It is not meant that a single letter becomes clear and
then totally disappears, but rather that a small group of letters
grows clear in the confused picture, fading again as another
group rises into view. The speed of this emergence is deter-
mined by the audible or silent speech. The emergence itself
usually takes place in syllables." 1

It is evident from this account that Dodge does not
rely on his visual memory of words, but that his
verbal memory is purely kinassthetic.

Another writer, Strieker, describes his verbal
imagery as being purely kinaesthetic. He compares
himself when engaged in silent thought to a piano-
player that runs his fingers over the keys without
actually striking them. The thought is portrayed
in movement, not in sound.2 He says of an imaginary
conversation :

"I speak first for myself in motor word-images; then I
reply for the other party — also in motor word-images." 3

1 Loc. cit., p. 15.

2"Studien uber die Sprachvorstellungen," p. 16.

* Loc. cit., p. 93.

THE VERBAL IMAGE 51

Strieker's primary auditory memory seems to be
clear, for he says :

"Immediately after a stranger has spoken to me, I can
easily recall his voice and the words that he uttered. This
memory gradually fades. The words remain in my memory;
but not always the voice. For instance, I can recall the exact
words with which a beggar accosted me in the street a few days
ago ; I can recall his appearance, but I have not the faintest
memory of his voice." 1

Strieker's secondary memory is apparently purely
kinaesthetic ; for he says of it :

"When I close my eyes to assist concentration, and allow
some verbal thought to pass through my mind, a familiar verse,
for instance (and ignore meanwhile specific occasions upon
which I have heard it) ; then I seek in vain for any memory of
sound that attaches itself to the words." *

With Strieker, distinctions between similar words are
fell, and not heard, for he says :

"Despite the manifold differences displayed by the letters
B, P, and M when they are actually pronounced, I find no
difference in them in thought but the characteristic labial
feelings. No matter how carefully I examine the words 'pater '
and 'mater' in silent thought, I find that the only difference
between them is the feeling of the p or the m." 8

Strieker, like Dodge, does not think in visual images
of words. His verbal memory is almost exclusively
kinaesthetic.4

1 Loc. tit., p. 19. * Loc. tit., p. 19.

1 Loc. cit., p. 10. 4 Loc. tit., p. 20.

52 THE PSYCHOLOGY OF STAMMERING

The above introspections furnish convincing evi-
dence in support of a purely kinaesthetic verbal mem-
ory. If further evidence were necessary, it could be
found in the characteristics of certain pathological
cases. One or two of these will be cited in a later
chapter. In such cases, which are admittedly rare,
it is found that the patient retains command of
verbal thought and speech despite the fact that the
brain-centre is destroyed in which the auditory word-
images were stored. It is obvious that the word-
memories can remain only in terms of feeling. The
patient is an articulo-moteur .

But the average person is neither an articulo-
moteur nor an audile. He is an audito-moteur , and
his verbal imagery is of the mixed type. In recalling
words, he both feels and hears them. This fact is
convincingly demonstrated by the various speech-
disturbances that follow the destruction or impair-
ment of either of the brain-centres that preside over
the kinaesthetic and auditory verbal memories. When
either of these centres is destroyed, internal language
is usually impaired. When only the auditory centre
is impaired, the patient often utters unintelligible
gibberish (jargon-aphasia). If his verbal memory
had been purely auditory, he would have become mute.
If it had been purely kinaesthetic, his language would
have remained unaffected. But the fact that his
speech becomes distorted shows conclusively that the

THE VERBAL IMAGE 53

kinaesthetic centre is acting without the directory
influence of the auditory centre. These facts show
that the cooperation of both centres is usually requi-
site for normal internal speech. The matter will be
better understood after a perusal of the two suc-
ceeding chapters.

Introspection reveals the presence of both the motor
and auditory elements in the average person. Among
nearly a hundred persons, Strieker found only one
that was conscious of no feeling in the lips when
mentally pronouncing the letters M, B, and P.
Among nearly sixty, only two failed to detect these
feelings when reading.1 The average audito-moteur
is unable to think the explosive and labial consonants
clearly when the mouth is open and the tongue pro-
truded. The unnatural position of the articulative
organs seems to obstruct the incipient movements
that accompany articulation. Such words as bubble,
wobble, toddle, mimicry, kindergarten, etc., then appear
thick and unnatural, — as though one were speaking
them with the lips apart.2

With many audito-moteurs the motor tendency is
so pronounced that actual movements of the speech-
organs occur during silent thought, and in exceptional
cases people may talk aloud instead of thinking to
themselves.

1 Loc. cit., p. 49.

* The difficulty disappears if the test is long continued.

54 THE PSYCHOLOGY OF STAMMERING

Concerning the articulatory tendency Bain says: l

"When we recall the impression of a word or sentence, if
we do not speak it out, we feel the twitter of the organs just
about to come to that point. The articulating parts — the
larynx, the tongue, the lips — are sensibly excited ; a suppressed
articulation is in fact the material of our recollection, the in-
tellectual manifestation, the idea of speech."

And thus Wyllie:2

"I find, when I mentally sing a song, with or without its
words, that it is impossible to prevent my pomum adami from
moving upwards when the melody passes into its highest
notes; but at the same time, I am most clearly conscious of
the varying pitch and cadence of the internal voice."

The present writer can distinctly feel the movements
of the larynx when thinking a vowel with rising in-
flection. The auditory image, however, is weak.
After thinking the vowel for a minute there is a dis-
tinct aching in the larynx, due beyond doubt to the
tension of the vocal cords. The writer has experi-
enced the same aching sensation in the larynx after
conversing for a quarter of an hour with a man that
was compelled by a throat affection to whisper.

This last phenomenon gives proof of sympathetic
movements during the act of listening. Many
psychologists have described this inchoate articula-
tion. Thus Strieker, for instance: 3

1 Bain, "The Senses and the Intellect," 4th ed., p. 357.

1 Wyllie, "Disorders of Speech," p. 237. 3 Loc. cit., p. 49.

THE VERBAL IMAGE 55

"I noticed these feelings first of all in the lips when any one
read to me with clear articulation. Each M, P, or B of the
speaker was accompanied by these labial feelings. Soon after-
wards I noticed that, when listening to clearly articulated
speech, I followed each word with an internal articulation of
my own."

Strieker finds further evidence of this concomitant
articulation in the fact that he remembers words
long after he has forgotten their sound.

Bain also makes reference to these sympathetic
speech-movements :

"While intently listening to a speech, we are liable to follow
the speaker with a suppressed articulation of our own, whereby
we take the train of words into a vocal embrace, as well as re-
ceive it passively on the sense of hearing." l

The foregoing arguments should establish the prac-
tical universality of the motor tendency in internal
speech. Internal audition is, however, no less prev-
alent. Just as Strieker has found by inquiry that
ninety-nine persons in a hundred are conscious of
the motor tendency in silent speech, so the present
writer has ascertained that no less a proportion are
clearly conscious of internal audition. However,
this fact receives general recognition; it would be
supererogatory to argue in favor of it. Even Strieker
and Dodge are not entirely devoid of auditory
imagery. The latter says of his aural memory :

1 Loc. tit., p. 371.

56 THE PSYCHOLOGY OF STAMMERING

"In an imperfect manner I am able to redintegrate auditory
images. I can give my verbal images the timbre of my father's
voice, — but this only with difficulty, and the attempts are
often fruitless. A visual image of my father is an invariable
prerequisite. I know, for instance, that my father has often
employed the expression 'My boy' when conversing with me.
But I find no trace of an auditory memory of my father's voice
when I express the silent judgment, ' My father has often used
the phrase, "My boy." Even with the greatest pains I can-
not imagine the peculiarities of his voice. This is possible
only when I have a definite visual image of my father, and
imagine a specific occasion for his speaking." 1

And again :

"Immediately after I have heard some one speak, I can
recall his words with the greatest clearness. But these fade
quickly, and usually no auditory memory remains. Similarly,
it is difficult for me to obtain an auditory memory of my own
voice. When I speak a word and attend especially to the
auditory impressions, I am able for some time afterward to
reproduce the acoustic image at will. But this ability dis-
appears, too, after a while; and all traces of sound are soon
lost in the imagery of movement." 2

The above paragraphs make it clear that Dodge
is not entirely lacking in auditory imagery ; though
the imagery is obviously weak. Dodge gives it as
his opinion that the fulness and roundness of his
verbal images subsists not only in vibration-feelings
in the larynx and thorax, but also in "a kind of un-
localized, evaporated auditory imagery" that be-

1 Dodge, loc. cit., pp. 15-16. 2 Loc. tit., p. 17.

THE VERBAL IMAGE 57

comes only in exceptional circumstances a clear and
independent reproduction.

Strieker, likewise, is not entirely destitute of audi-
tory memory. He is sometimes able to recall a
person's voice by first visualizing his figure, or by
clearly imagining the circumstances under which
particular words were spoken. The memory is then
of words as uttered upon a particular occasion, rather
than of words as having a specific meaning.

An important fact must be noted at this point:
In recalling the voice of a particular person, the audito-
moteur does not necessarily resort to pure auditory
imagery. Strieker's "open-mouth test" will show
that the labial and explosive consonants are as much
motor as ever. The characteristic timbre of the voice
is represented only in the vowel ; and it is this part
of the word that is mentally heard. The writer finds
that this is the case with his own imagery. He can
on rare occasions recall the peculiar pronunciation
that a certain Oriental friend accords to his name.
But introspection shows that he is himself mentally
pronouncing the word, and that the characteristic
quality of the remembered voice is present only in
the vowel of the last syllable. The case is similar
with the primary memory. The word is present as
an auditory-motor image; the consonants are dis-
tinctly felt, but the characteristic auditory element
inheres only in the vowel.

58 THE PSYCHOLOGY OF STAMMERING

From the foregoing arguments it should be clear
that the average person is an audito-moteur. His
verbal imagery is of the mixed type. When thinking
silently in words, he both hears them and feels them.1
If his acoustic memory is strong, he may have a sound-
image of the entire word, and kinaesthetic images of
only the grosser muscular movements; i.e. chiefly
of the consonants. His verbal image will then have
a binary, or dual, form. For consciousness, however,
one image will be, as it were, superposed upon the
other, and the images will appear to the mind as a
unit — or, if introspection is keen, as a composite
image. If, on the other hand, the acoustic memory
is weak, there will be an auditory image of only the
vowel. The consonants and grosser muscular move-
ments of speech will be represented in kinaesthetic
imagery, and the verbal imagery will in actuality be
composite.2 In either case the presence of the audi-

1 There appears to be also an auditory-motor musical memory.
Some people are unable to recall a tune without mentally humming
it, singing it, or playing it upon a musical instrument. The sounds
can be redintegrated only when they are associated with the kin-
aesthetic memory of specific movements. The movements are prob-
ably recalled first, the sounds being awakened by association.

2 Various phenomena indicate that the word is normally repre-
sented in the brain by a plurality of cells. One may, for instance,
remember the initial consonant of a word (in terms of feeling), but
be unable to recall the word in its entirety. One may interchange
the initial consonants of contiguous words and syllables (achoppe-
ment syUabique), etc., etc.

THE VERBAL IMAGE 59

tory image will be required for normal verbal thought
and normal oral expression.

The feeling-element of speech has in this discussion
been treated as exclusively kinaesthetic. This has been
done for the sake of simplicity. In reality, the feeling-
element does not comprise merely the consciousness of
muscular movement or muscular action, but it em-
braces in addition tactual sensations, — sensations of
contact, friction, and the like. The fricatives, /, v, s,
th, etc., are as much tactile in their representation as
they are kinaesthetic. The matter is more readily un-
derstood by regarding the sensations rather than the
mental images. In pronouncing the letter /, for in-
stance, the only muscular movement involved (neglect-
ing respiration) is that of bringing the lower lip into
contact with the upper teeth. In this act one is con-
scious of the contraction of the labial muscles ; but one
is also conscious of certain characteristic cutaneous
sensations. After the initial movement has been per-
formed, there is practically no muscular activity in the
articulative organs. There may be a slight tension in
the muscles of the lower lip from which one could de-
rive kinaesthetic sensations ; but if the consonant is con-
tinuously produced, the more conspicuous sensations are
undoubtedly tactual. The tactual impressions in this
case consist of the sensation derived from the contact
of the upper teeth with the lower lip, and the sensation

60 THE PSYCHOLOGY OF STAMMERING

produced by the passage of the air through the labial
aperture. It is evident, then, that a continuous / -
since it occasions marked tactual sensations in actual
enunciation — must be mentally represented largely
in tactual terms. An / that is not continuously pro-
duced contains these sensations no less than one that
is prolonged ; there is a difference merely in duration.
Similar arguments can be adduced in support of the
tactual element in all the continuous consonants.

The explosive consonants involve a greater amount
of muscular activity ; but they contain, nevertheless, a
marked tactual element. Taking the letter b, for ex-
ample, we find that a tactual sensation is derived from
the contact of the two lips. As the labial pressure is
increased to resist the air-column, there is naturally an
increased muscular tension giving rise to kinaesthetic
sensations. But there is also an increased pressure
by the air-column upon the inner surfaces of the lips,
and this produces a characteristic tactual impression.
The explosive consonants, then, as well as the con-
tinuous consonants, give rise to tactual sensations, and
they are represented by tactual images in the mind.

There is no strict line of demarcation between
the kinaesthetic and tactual elements. Kinaesthetic
sensations may be regarded as tactual sensations from
muscular, tendinous, and articular surfaces. They
are internal tactual sensations, or tactual sensations
derived exclusively from the muscular system.

CHAPTER IV

THE BRAIN

THE brain comprises the cerebrum and the cere-
bellum (or little brain). The cerebellum lies below
the cerebrum, in the posterior part of the cranium.
It stands in anatomical connection with the cerebrum
and spinal cord. The cerebrum is divided by the
median fissure into two more or less symmetrical
hemispheres. It presents a surface characterized by
numerous irregular furrows and convolutions. The
cerebellum contains three definite lobes, of which
the median lobe is rudimentary. To the naked eye
the cerebellum presents a regular, laminate structure.
The great mass of the brain consists of white matter,
composed chiefly of fibres. There is a superficial
layer of gray matter, two or three millimeters thick.
This surface-layer — consisting chiefly of cells —
is called the cortex.

The principal fissures of the cerebrum are the median
fissure, the fissure of Sylvius, and the fissure of Ro-
lando. These last two, with the parieto-occipital
fissure, divide the external surface of the hemisphere 1

1 In discussing the fissures and convolutions, one hemisphere is
taken for the sake of simplicity.

61

62 THE PSYCHOLOGY OF STAMMERING

into its four principal lobes. These are the frontal,
parietal, temporal, and occipital lobes, named after
the bones of the skull to which they lie contiguous.

The frontal lobe comprises the first, second, and
third l frontal convolutions,2 and the precentral
convolution, which lies just anterior to the Rolandic
fissure. The temporal lobe embraces the ventral
aspect of the hemisphere. It contains the first,
second, and third 1 temporal convolutions. The oc-
cipital lobe comprises the first, second, and third 1
occipital convolutions, — in the posterior part of the
hemisphere. The parietal lobe lies posterior to the
fissure of Rolando. It contains the postcentral con-
volution, the superior parietal lobule, the supra-mar-
ginal gyrus, and the angular gyrus.

The mesial aspect of the hemisphere 3 displays the
marginal gyrus, the gyrus fornicatus, the hippo-
campal gyrus, the uncinate gyrus, and the quadilateral
and cuneate lobules. The island of Reil, another small
group of convolutions, is found at the bottom of the
fissure of Sylvius.

The gray cortex of the brain follows each of the
different folds and convolutions; thus the entire
surface of the brain is composed of a layer of cells.

The cells of the cortex are in direct connection with
the white fibres that compose the great mass of the

1 Also designated superior, middle, and inferior.
* See Figure i. * See Figure 2.

THE BRAIN

THE PSYCHOLOGY OF STAMMERING

THE BRAIN

brain. The cell-body and its numer-
ous filaments and ramifications con-
stitute a functional unit, known as a
neurone.1 The brain consists simply
of neurones, with the neuroglia — or
supporting tissue — and a rich supply
of blood-vessels. The filaments pro-
ceeding from the cell-body vary in
length from the merest fraction of a
millimeter to several feet, the longer
fibres, of course, extending beyond the
brain. The shorter filaments form
connections between the different cells
themselves (these are the association
fibres), while the longer fibres con-
vey stimuli from the sense-organs or
carry impulses to the muscles. The
fibres that convey the ingoing stimu-
lus are known as sensory, or afferent,
nerves. Those conveying the out-
going stimulus are known as motor,
or efferent, nerves.

1 Donaldson estimates that there are not less
than three thousand million neurones in the
central nervous system. (See "The Growth o^
the Brain.")

Figure 3 represents the cells of the cerebral
cortex magnified 114 diameters (Ferrier, after
Be van Lewis).

FIG. 3.

66 THE PSYCHOLOGY OF STAMMERING

Thus there are three distinct classes of nerve-fibres,
— the association-fibres, the sensory fibres, and the
motor fibres. The association-fibres may be sub-
divided into long and short unilateral fibres, and
transverse fibres. The transverse fibres connect
convolutions in the opposite hemispheres.1 The long
unilateral fibres unite cells in different convolutions of
the same hemisphere. The short fibres connect cells
that are practically contiguous.

There is a decussation of the sensory and motor
nerve-fibres, so that the left hemisphere of the brain
stands in connection with sense-organs and muscles
of the right side of the body, while the right hemi-
sphere of the brain is connected with the left side of
the body. There is an exception in the case of the
olfactory tracts. The case of vision is somewhat
anomalous. The left half of each retina is in con-
nection with the left hemisphere of the brain, while the
right halves of the retinae are connected with the right
hemisphere. Thus an injury to the visual area in the
left cortex results in blindness to the left halves of
both retinas; consequently there is an obliteration
of the right field of vision.

As already stated, the muscles of one side of the
body are connected with the hemisphere of the op-
posite side. The right hand is moved through the

1 The principal band of transverse fibres is known as the corpus
callosum. (See Fig. 2.)

THE BRAIN 67

activity of cells in the left cortex; the left hand is
moved through the activity of cells in the right cortex.
This principle holds good for movements that are
executed unilaterally. Movements that are invari-
ably executed bilaterally are represented in only one
hemisphere of the brain.1 This is true of the articu-
lative movements concerned in speech. In right-
handed persons, speech-movements are initiated from
the left hemisphere. In left-handed persons, they are
initiated from the right hemisphere.

This brings us to the matter of cerebral localization.
It is found that the brain-cells controlling particular
muscles of the body or subserving particular sense-
organs are not scattered promiscuously throughout
the cortex, but are localized in fairly well-defined
brain-areas or convolutions. This fact has been
demonstrated in a variety of ways. It has been
established by experiments performed upon animals
-usually monkeys. After the cortex has been ex-
posed, different areas are electrically stimulated.
It is found that stimulation of definite areas of the
brain results in the contraction of definite muscles.
Certain areas control the movements of the leg;
others control the movements of the arm. These
areas can be subdivided, and definite localities assigned

1 This statement is capable of qualification. To avoid complica-
tion and irrelevant discussion the principle is stated without its
restrictions.

68 THE PSYCHOLOGY OF STAMMERING

for the control of the shoulder, forearm, hand, index
finger, thumb, etc. The movements occur, of course,
on the opposite side of the body. When the stimulus
is applied to the area that controls the muscles of the
face, the resultant movements are generally bilateral.
The sensory areas have been determined by extirpa-
tion of different portions of the cortex. Excision of the
occipital areas leads to blindness; destruction of the
temporal areas induces loss of hearing. Ablation of
a motor area, of course, results in paralysis of the re-
lated muscles.

Investigations upon animals have been confirmed
by experiments performed upon human beings when
the cortex has been exposed by injury. The motor
areas can be determined by electrical stimulation.
An injury or tumor in these same areas results in
paralysis. An injury in one of the sensory centres
results in blindness, deafness, or in loss of the images
of sight or hearing, according to the seat of the damage.

The site of the sensory centres is further indicated
by cerebral atrophy. If a child is born blind or deaf,
his visual or auditory brain-centre never becomes
functionally mature. In many cases atrophy or
softening takes place in the centre affected. The loca-
tion of the degenerated area indicates, of course, the
seat of the sensory centre

The site of the different cerebral centres has like-
wise been demonstrated by the embryonal method.

THE BRAIN 69

Different fibres acquire their myelin sheaths at dif-
ferent periods; thus they can be traced from the
peripheral senses-organs to their termination in the
cortex.

The general motor area of the brain is situated hi
the Rolandic region. Figure 4 shows on the human
brain the various subdivisions of the motor area as
ascertained by Beevor and Horsley through experi-
ments on the bonnet monkey. The researches of
some other investigators seem to indicate that the
true motor area lies anterior to the Rolandic fissure,
and that the region posterior to the fissure embodies
the corresponding sensory areas for the reception of
tactile, thermal, kinaesthetic sensations, etc. The
opinion of physiologists is by no means unanimous on
this point, and it is held by many that the region on
both sides of the Rolandic fissure is sensory-motor,
rather than motor on one side and sensory on the
other. Investigation is difficult, since destruction of
the sensory regions impairs the motor functions.
Fortunately this matter does not vitally concern the
discussions of the present monograph.

It will be noticed that the centre for the control
of the oral and vocal mechanism is at the foot of the
precentral and postcentral convolutions. In the
orang-outang this centre appears to be confined to
the precentral convolution. A similar localization is
made by most physiologists in regard to human beings.

70 THE PSYCHOLOGY OF STAMMERING

I

j

~0

o

THE BRAIN 71

The subcentre for the oral articulative mechanism is
supposed to lie posterior to that for the vocal mechan-
ism. The motor fibres from the speech-centre pass
to the motor centres in the medulla oblongata,1 these
centres being in direct connection with the organs of
speech.

The region of the uncinate gyms and hippocampal
gyrus is regarded as the site of the olfactory and
gustatory centres. The area for the reception of
visual impressions is located in the occipital lobe,
chiefly in the neighborhood of the cuneate lobule.
The auditory area is found in the temporal lobe, espe-
cially in the first and second convolutions. Each of
these "internal sense-organs" 2 stands connected with
the peripheric sense-organ of the opposite side of the
body. Both hemispheres of the brain are active dur-
ing the reception of simple sensations of sight, hearing,
etc.

The memory-centres 3 are remarkable in that they
are located in the left hemisphere of the brain in
right-handed persons, and in the right hemisphere
in left-handed persons. The reason for this phenome-
non and for dextrality is somewhat of a biological
mystery. Bastian has found that the specific gravity

1 The bulb of the spinal cord, which lies within the cranium.

1 With the exceptions stated on page 66.

1 By a memory-centre is meant a centre presiding over a partic-
ular type of mental imagery. The term does not imply that the
centre is necessarily devoid of sensory function.

72 THE PSYCHOLOGY OF STAMMERING

of the cortical matter of the frontal, parietal, and
occipital regions is greater in the left hemisphere than
in the right. This phenomenon is probably in the
nature of effect rather than cause. Ogle has sug-
gested that dextrality is occasioned by certain
peculiarities in the mode of development and distri-
bution of the left and right carotid arteries. A
freer blood supply to the left hemisphere is invoked
as the cause of this hemisphere's earlier development.1
But if a freer blood supply to the left hemisphere were
to account for its earlier development, it would not
necessarily follow that the earlier development of
the hemisphere explains its exclusive control of
memory.

The confinement of the memory-centres to one
hemisphere probably renders possible a greater rich-
ness of associations; thus the phenomenon might
perhaps be explained by natural selection. In any
case, the fact remains that the memory-centres are
restricted to the left hemisphere in right-handed
persons, and to the right hemisphere in left-handed
persons.

The site of the memory-centres can be designated
with considerable accuracy. This is especially true
of the memory-centres concerned in speech, for the
slightest injury to a speech-centre at once gives rise

1 In many left-handed persons a freer blood supply has been found
to obtain for the right hemisphere.

THE BRAIN

73

to characteristic symptoms. The auditory verbal
memory is subserved by the posterior two- thirds of
the first temporal convolution (A. V. in Figure 5).
The anterior third of this convolution is generally
regarded as the seat of the musical memory. The

Fissure of Rolando

FIG. 5. — Diagram showing the approximate site of the principal memory-
centres of the brain (after Bastian). G. M., graphic-motor centre; K. V.,
kinaesthetic verbal centre ; G. A. C., general auditory centre ; A. V., auditory
verbal centre ; G. V. C., general visual centre ; V. V., visual verbal centre.

second temporal convolution is less important; it is
subservient (probably with some assistance from the
first temporal convolution) to the memory for ordi-
nary physical sounds. The kin&sthetic "verbal memory
is located in the posterior part of the third frontal
convolution (K. V. in Figure 5). The kinaesthetic

V

74 THE PSYCHOLOGY OF STAMMERING

verbal centre is known as "Broca's convolution."1
The graphic-motor centre, the centre in which are
stored kinaesthetic images of writing-movements, is
generally assigned to the posterior part of the second
frontal convolution (G. M. in Figure 5). This
localization is questioned by some investigators.2
The visual verbal memory — the memory for printed
and written words — is located in the angular gyrus
(V. V. in Figure 5). The general visual centre —
for the memory of concrete objects — occupies the
adjacent regions of the occipital lobe.3

It will be noticed that the visual memory-centre is
anomalous in that it does not coincide with the centre
for the reception of visual impressions, — the primary
visual centre. There appears to be no doubt, how-
ever, concerning the location of these two centres.
A lesion in the cuneate lobule results in hemianopsia, —

1 Broca was the first to point out the intimate connection of this
convolution with the function of speech. Broca's convolution was
at first regarded as a unitary speech-centre.

2 The centre for writing-movements is undoubtedly identical
with that for hand-movements. We know that kinaesthetic images
of writing-movements and of hand-movements exist. The psycho-
logical data are beyond question. The exact site of the brain-centre
is a matter of secondary importance; hence it would be useless to
discuss the merits of this allocation.

3 It must not be supposed that the position of each brain-centre
is strictly delimited. Along the borders there must necessarily be
considerable inter blending ; hence the adjunctive regions belong
equally to the two adjacent centres. A lesion in these regions would
affect both centres slightly, and neither of them radically.

THE BRAIN 75

blindness in one half of the visual field; but if the
lesion is limited, it does not necessarily affect the
visual memory. On the other hand, an injury to
the angular gyms and its adjacent region obliterates
the visual memory, yet leaves physical sight unim-
paired. The patient then sees quite clearly, but is
unable to recognize objects and unable to think in
terms of sight. These facts seem to indicate that
there are discrete centres for the reception and re-
tention of visual impressions. — A like condition may
obtain for the other senses. There is some slight
evidence for it in the case of audition.

The kinaesthetic memory-centres are anterior to
the fissure of Rolando. This fact indicates that the
somaesthetic area is not confined to the region posterior
to the fissure of Rolando or that the sensory and
memory centres in this instance do not coincide.

Large portions of the cortex seem to be neither
sensory nor motor. They are regarded as associa-
tion areas. The cerebellum is not an organ of con-
scious intelligence. It is intimately connected with
the maintenance of equilibrium, and its function seems
to be in general a coordinating one.

From the foregoing discussion it is manifest that
we have not only memories rather than memory,
but also brains — or brain-centres — rather than a
brain. We have an auditory brain, a visual brain,

76 THE PSYCHOLOGY OF STAMMERING

a kinaesthetic brain, and so on. These different
brains, or brain-centres, may have different degrees
of activity, resulting in different degrees of vividness
in the various kinds of mental imagery. Different
brain-centres participate in different acts of percep-
tion and conception. In some mental processes,
all the brain-centres may be active; in others, per-
haps only one or two.

In the reception of a simple sensation, the activity
of only one brain-centre is necessary.1 There are
no associations; the mental process is complete
when the sensation has become enregistered in the
brain-cells. With perception or conception the mat-
ter is different; the stimulus must travel from one
centre to another. To take Charcot's classical
illustration of the child and the bell (and to consider
first the manner in which the various elements of
the percept or concept are established)- : 2 — The child
takes the bell into his hands and receives a set of
tactual sensations, the sensory stimulus travelling
along the afferent nerves to the somaesthetic area of
the brain and impressing itself in the cortex. At the
same time the child sees the bell : ether waves affect
the retina of the eye, and the afferent current travels
along the optic nerve and effects chemical changes
in the cells of the optic lobe. As the child hears the

'The right hemisphere is neglected for the sake of simplicity.
* See Ballet, "Le langage interieur et 1'aphasie," ad ed., pp. 6 ff.

THE BRAIN 77

bell, air-vibrations impinge upon the drum of the ear,
and the stimulus is conducted along the auditory
nerve to the auditory brain-centre, where the impres-
sion is enregistered. Kinaesthetic impressions are
similarly enregistered in the cortex. Thus there are
at least four brain-centres subserving the child's
concept of the bell even before he has learned to talk.
And now for the act of perception. When the child
sees the bell on some subsequent occasion, the ap-
pearance of the object arouses memory-images of
its sound and of the feeling derived from handling
it.1 The excitation travels from the primary visual
centre to the secondary, or memory, centre ; whence
it radiates to the auditory, tactile, and motor memory-
centres. If one of these centres should be impaired,
or if a set of association-fibres should be severed, the
act of perception would remain incomplete. With the
auditory perception the process is similar. Cells in
the auditory centre are first excited ; then the stimu-
lus is diffused into the visual, tactile, and kinaesthetic
centres; and the sound of the bell arouses mental
images of its appearance, feeling, etc. If the child
were to feel the bell in the first place, the tactual
sensation would (by this process of irradiation) arouse
mental images in the auditory and visual centres,
and the perception would be complete.

1 With a young child several repetitions of the experience would
be necessary to establish the associations.

78 THE PSYCHOLOGY OF STAMMERING

Obviously there are numerous different doors
through which the percept can be aroused. The bell
may be visually perceived as one catches sight of it ;
it may be tactually perceived as one grasps it in the
dark ; and it may be auditorily perceived as one hears
it in another part of the house. In any one of these
cases the bare sensation would be practically meaning-
less if the stimulus were not to travel beyond the
"receptive" centre and arouse the associated mental
images.

Taking, for further illustration, the percept of an
orange, we have two new classes of sensations that
may arouse associated images. The orange may be
perceived if it is merely smelled. It may be per-
ceived equally well by taste. The mental process
becomes a perception, rather than a sensation, when
the stimulus travels from the gustatory or olfactory
centre to the memory-centres for visual and tactual
impressions.

It is evident that the conceptual and perceptual
processes are analogous. The nucleus of the percept
is the sensation occasioned by the stimulus to the
peripheric sense-organ : the activity of the cortical
cells is instigated from without. The nucleus of the
concept is a mental image — produced by the idio-
activity of the memory-cells. An illusion — a false
perception — is due to the fact that the excitation trav-
erses inappropriate fibres and reaches an inappro-

THE BRAIN 79

priate cell. Illusions occur most frequently during ex-
pectancy, — that is, when particular memory-cells are
unusually active or "excitable." It seems as though
an efferent current comes out to meet an afferent
current and diverts it from its proper course. In
hallucination (as distinguished from illusion) the
memory-cell reaches plenary activity without external
stimulation. The mental image is then mistaken for
a sensation.

Concepts and percepts are further complicated by
the introduction of language. In the cases cited
above, the word bell or orange is introduced as an
integral part of the concept. When the word is
heard or thought, the various associated images arise
in the foreground of consciousness or appear in the
"fringe." Conversely, if the bell or orange is seen,
or is thought of in any form of mental imagery, its
name is aroused by association.

Wyllie performed an interesting experiment to
illustrate the mental processes in perception,1 — using
a number of children as subjects. He called one boy
into the room and showed him an apple lying upon
the table. The boy was asked to state what the ob-
ject was. The answer came at once, "It is an apple."
The second child was permitted to smell the apple after
his eyes had been bandaged. He likewise named the
object immediately. The third boy had a piece of

1 "Disorders of Speech," pp. 227 ff.

8o THE PSYCHOLOGY OF STAMMERING

an apple placed in his mouth. The fourth had an
apple placed in his hands. Both of them named the
object correctly. With other subjects the apple was
pared close to the ear, so that the sound could be
plainly heard. Many of them recognized the sound.
The final experiment was an appeal to the kinaesthetic
sense. An artificial apple, made of metal, was placed
upon the table. The imitation could not be detected
by the eye, but the deception was immediately
recognized when the apple was taken into the hands.

In these different acts of perception the word-
image apple may have been directly aroused by the
sensation, or it may have been indirectly invoked
through one of the awakened mental images. In any
case the word is aroused by the overflow of the mental
"current" into the adjoining brain-centres. The
process is dependent upon the integrity of the brain-
cells and fibres concerned. It is found in some
pathological cases, where certain brain-fibres have been
severed, that a person may recognize an object placed
in one hand though he cannot recognize it when it is
placed in the other. The break in the fibres furnishes
a check to the mental current, so that it cannot pass
into the adjoining brain-centres and awaken the
associated mental images.1

In the case of the congenitally blind or congenitally
deaf, whole brain-centres are ruled out of the per-

1 In such cases the interruption is probably in the transverse fibres.

THE BRAIN 81

ceptual and conceptual processes. The mental current
can never enter these areas to awaken visual or au-
ditory ideas. If the person is both blind and deaf,
the mental current is restricted almost exclusively to
the anterior portion of the brain. If the visual or
auditory areas become damaged later in life, when the
person is dependent upon his images of sight and hear-
ing, mental efficiency is greatly impaired.

In the foregoing discussion the word-image has
been treated as though it were a unitary image that
could be aroused through the activity of a single
brain-centre. Such may be the case in rare instances,
— in the typical audile, for instance. But, as we
have seen in the preceding chapter, the word-image
is usually complex, and its appearance in conscious-
ness often requires the activity of a number of dif-
ferent centres.

We may consider first the simple memory-image of
the spoken word uncomplicated by visual images of
written or printed words or by kinaesthetic images
of writing-movements. In this case the word-image is
subserved by the kinaesthetic verbal centre and the
auditory verbal centre (K. V. and A. V. in Figure 5).
With the articulo-moteur the activity may be limited
in silent thought almost exclusively to the centre
K. V. This person feels his words when thinking
them. When the activity begins in A. V. (as he is

82 THE PSYCHOLOGY OF STAMMERING

listening to the speech of another person) there is an
overflow into K. V., and he mentally articulates the
words as he hears them. With some motor-minded
persons the activity of K. V. appears to be indis-
pensable for silent thought and the interpretation of
spoken words. A lesion in the kinaesthetic verbal
centre then impairs silent thought and renders the in-
terpretation of spoken language extremely difficult.

With the average person the activity of both K. V.
and A. V. is essential for silent thought. The more
prominent articulative movements are mentally felt,
and the whole word — or simply the vowel — is at
the same time mentally heard. The activity com-
mences in K. V. and flows into A . V. Frequently the
mental process remains incomplete. One remembers
the letter that begins a particular word without being
able to recall the rest of it. (There are no visual
images present: the initial articulative movement
is simply felt.) It seems that the neural current is
checked in its passage from K. V. to A. V., or that the
cells in A. V. are abnormally torpid.1

When the auditory tendency predominates, the
activity may perhaps begin in A. V. and overflow
to some extent into K. V. This is an inverted order
of association, and probably does not usually occur.
When the image is initiated in the centre A. V., it

1 The idea of a neural current is more or less a working hypothesis.
It is not known exactly what takes place in the brain during thought.

THE BRAIN 83

has, without the addition of the motor image, the
"fulness" and "roundness" of a mental word.
When the image is initiated in K. V., it is often at-
tenuated till A. V. has supplied the mental sound.
Conjoint activity of the two centres is necessary in
the latter case, but not in the former. When the
activity begins in A. V., the person is probably a pure
audile.

With the educated person the kinaesthetic and
auditory verbal centres are supplemented by two
centres connected with the faculty of reading and
writing. These are the visual verbal centre, pre-
siding over images of printed and written words, and
the graphic-motor centre, presiding over the kinaes-
thetic memories of writing-movements (represented
respectively as V. V. and G. M. in Figure 5). The
centre V. V.\ in the angular gyrus, plays a prominent
part in verbal representation with eye-minded people.
The activity begins in V. V and flows into K. V. and
A . V. This happens when the person reads his words
from an imaginary printed strip, or sees them before
him in any form of visual imagery. The activity
may in rare instances be confined to V. V. ; in this
case the visual image of the word does not arouse the
image of the spoken word. This happens with the
deaf-mute that has learned to read and write, but not
to speak. The associations of meaning are attached
directly to the visual image as a nucleus. With all

84 THE PSYCHOLOGY OF STAMMERING

persons the activity commences in V. V. during the
act of reading; it then passes into K. V. and A. V. as
the printed word arouses the memory of its spoken
correlate.

With the visile, the auditory impression of a word
frequently awakens the associated visual verbal
image. In this case the activity flows from A . V. into
V. V. : the stimulus passes from cells in the first tem-
poral convolution and along the associational fibres into
the angular gyrus, where the related cells are excited.
If the words are to be written from dictation, the
stimulus passes on to the graphic-motor centre, and
kinaesthetic images of the necessary hand-movements
are provoked.

The graphic-motor centre, unlike the three other
verbal centres, plays no prominent part in verbal
thought. The reason for this is undoubtedly found in
the complexity of the imagery that it subserves. The
graphic-motor image would, by its duration, materi-
ally impede the thought-processes. The other verbal
images can arise instantaneously, and for this reason
are better adapted to verbal thought. The graphic-
motor image does, however, frequently arise in the
motile during moments of preoccupation. This is
especially true of the subject that spends much of his
time in writing. As he hears a word to which he is
paying no particular attention, or thinks a word in
a casual way, he may find himself mentally penning

THE BRAIN 85

the letters that compose it. This phenomenon is
due to the passage of the stimulus into the centre
G. M. The present writer, in whom motor images
are signally strong, frequently experiences a curious
obtrusion of the kinaesthetic images. As a word rises
in the mind during a moment of abstraction, he fre-
quently finds himself mentally tapping the word out
on a typewriter. There is seldom present a visual
image of the keyboard. When it appears, it is rudi-
mentary to the last degree. There is no mental
imagery of sound. The overflow is confined to the
hand-movement centre. If it passes to the visual
centre, the current is either too weak or the cells are
too torpid to permit the arousal of a clear visual image.
If the current passes to the auditory centre, it is again
too weak, or it meets with insuperable inertia.1

1 In the case of the writer, the visual images are usually vestigial
or schematic. Auditory images are practically non-existent.

CHAPTER V

THE RELATION BETWEEN MENTAL IMAGERY AND
VOLUNTARY SPEECH

WHAT is the cause of a voluntary muscular move-
ment? Exactly what is it in the mind that directs
such a movement as lifting the arm, for instance?
Why is the act invariably the appropriate one, and
why does one not protrude the tongue or suddenly
sit down instead of executing the arm-movement in-
tended ? The opinion that finds the widest acceptance
among psychologists is that the immediate provo-
cative of a voluntary movement is a mental image of
the effect that the movement will produce. This
effect may be the feeling of the movement itself, or
the impression of certain results that the movement
produces indirectly.

The memory of the direct effect James calls the
resident image.1 It is the tactile memory of the
different cutaneous sensations, and the kinaesthetic
memory of tendinous strain, contraction of the mus-
cles, movement of the joints, etc. The indirect effect
of the movement may be the sound of a bell, a note

1 " Principles of Psychology," Vol. II, pp. 488 ff.
86

MENTAL IMAGERY AND VOLUNTARY SPEECH 87

from a violin; it may be a tactile sensation as one
plunges the hands into water, an olfactory sensation
as one lif ts a rose to the nostrils, or a gustatory sensa-
tion as one raises a cup of coffee to the lips. This
resultant sensation James calls the "remote" effect.
The memory of it is the remote image. Apparently,
either the resident or the remote image may excite
a muscular movement. It is probable, however,
that when the remote image appears to be the sole
instigator of the movement, the resident image is
really sandwiched in between the remote image
and the movement executed. It would be quickly
swamped by the kinaesthetic sensations.

Kinaesthetic images have a remarkable propensity
for self-expression. With many persons they give
rise to incipient movements. Thus we see the per-
son that moves the lips while reading or thinking
intently, and the person that thinks aloud. These
movements might be ascribed to the remote as well as
to the resident image, but it is easy to show that the
resident image is always straining at the leash and
endeavoring to express itself in movement. Let the
reader place an arm upon the table, and rigidly con-
tract its muscles. Then let him endeavor to obtain
in memory a clear feeling of the arm's relaxation.
Any degree of success is immediately accompanied
by a diminution in the tension of the muscles. Let
the reader then place both arms upon the table, and

88 THE PSYCHOLOGY OF STAMMERING

firmly contract the muscles of the right arm while
relaxing the muscles of the left. Let him then attend
to the feelings in the rigid arm and the relaxed arm
alternately. As he attends to the contraction of the
muscles in the right arm, the muscles of the left tend
to contract likewise. As he transfers his attention
to the left arm in order to effect its relaxation, the
tension of the right arm diminishes. In this case the
sensory impressions play the part that is usually
taken by kinaesthetic images.

Muscle-reading (the "willing game") is based upon
this propension of the kinaesthetic image for express-
ing itself in movement. The performance is usually
represented as mind-reading. The performer under-
takes to find, while blindfolded, a certain object that
has been hidden in the room. He takes the hand of
the "medium" (who of course knows where the object
is hidden), and proceeds to "receive" the thought,
the rest of the company meanwhile concentrating
intently in order to render "telepathic" assistance.
The medium is exhorted to "think hard," and so on.
In a few minutes the hidden object is found. What
happens is that the performer reads the little pulls
and tugs of the "medium's" hand, which the latter
is quite unconscious of making. As the "medium"
endeavors to concentrate his thought, his kinaesthetic
images become more intense or come more to the
foreground of consciousness, and without his knowl-

MENTAL IMAGERY AND VOLUNTARY SPEECH 89

edge they find expression in incipient movements.
Frequently these movements are so conspicuous that
the veriest novice could not fail to find the hidden ob-
ject. He is, in fact, led to the hiding-place. Usually,
of course, the movements are inchoate; but the ex-
perienced muscle-reader finds them sufficiently con-
spicuous for his purpose.

The resident kinaesthetic images are undoubtedly
the sole mental cues for the grosser muscular move-
ments. For the more delicate muscular movements
- those involved in whistling, singing, speaking,
etc. — the remote images cooperate. In the deaf
or blind, or in those that are both deaf and blind,
many of the remote images are lacking. The con-
genitally deaf learn to speak by feeling in the same
way that the congenitally blind learn to write by
feeling. The mental cues are in each case resident
rather than remote.1

1 The question naturally arises as to how the first movements
come to be performed in order that the resident images may be
established. The answer is found in the biological principle (ex-
pressed as the dynamogenic law) that living matter tends to convert
a sensory stimulus into a motor response. The child's earliest
movements are purely involuntary : he is nothing more than a pas-
sive spectator of what is going on. The earliest random-spontaneous
movements are generally bilateral ; they are the kicking of the legs,
and the waving of the arms. Later comes vocal play, — cooing,
babbling, etc. (usually prompted by feelings of bodily comfort).
The resultant images are enregistered in the mind, and the child is
later able to perform, voluntarily, movements that were at first

go THE PSYCHOLOGY OF STAMMERING

The question now suggests itself as to whether or
not one has any direct control of the emission of the
motor current. The most natural conception of the
matter is that the outgoing current is actually felt,
and that its discharge is under the direct control of
the will. It will be pretty generally conceded that
the motor current must be sentient if its emission
is to be voluntarily directed. But is the motor
current sentient? The current exists beyond a
doubt, but that its discharge is actually felt is
denied by many competent psychologists. What
is usually mistaken for the feeling of innervation
is nothing more than the kinaesthetic sensations —
the feelings from the muscles, tendons, articular
surfaces, etc.

That these feelings are afferent rather than efferent,

spontaneous. "It follows from this that voluntary movements
must be secondary, not primary functions of our organism." (James,
"Psychology," Vol. II, p. 487.) These earlier movements of the
child are, of course, elementary. When he has gained control of his
legs, arms, and fingers in the manner described, his further move-
ments are in the nature of combinations of these elementary move-
ments. The child's operations are henceforth voluntary, but for
many years he progresses very largely by trial and error.

All of the bodily movements are not necessarily random-spon-
taneous in their inception. Many of the earliest movements are
externally impressed upon the limbs.

It is obvious that but for memory the child would remain an
organism responding to external stimuli. With memory, he is
able to respond to internal stimuli; i.e. he is able to effect "volun-
tary" movements.

MENTAL IMAGERY AND VOLUNTARY SPEECH 91

is evident from the fact that one has an exact appre-
ciation of any movement that is externally impressed
upon the limbs. There can be no feeling of innerva-
tion in this case ; yet the sensations do not differ in
quality from those accompanying a voluntary move-
ment. Furthermore, accurate discriminations of
weight can be made when the muscles of the arm are
made to contract artificially by means of an electrical
stimulus (Bastian). There is no motor current pres-
ent, yet the amount of the muscular contraction
can be accurately determined. It is clear that the
feeling of effort and the supposed innervation-feeling
must in this case be purely afferent.

It will be noticed that these feelings inhere in the
muscles actually participating in the movement.
Hence, if the feeling emanates from the outgoing
current, it must be felt along the path of its discharge.
This being the case, it should be possible to trace the
course of the current through every nerve that it
traverses. The experiment of contracting the muscles
of the arm or leg will show that all consciousness of the
movement comes exclusively from the limb affected.
It is impossible to trace the motor channels through
the spinal cord, for instance. Hence one must con-
clude that only the ingoing current is felt.

The argument might be advanced that, even if
the motor current is not felt in the path of its dis-
charge, its emission is distinctly felt and controlled

92 THE PSYCHOLOGY OF STAMMERING

at its source. Introspection refutes the argument.
There are many fugitive sensations that might be
mistaken by the untrained psychologist for this
feeling of the effort of the will. Such, for instance,
are sensations from the contraction of the brow, the
tension of the scalp muscles, the occlusion of the
glottis, etc. But when these sensations are eliminated,
nothing further remains. The only feelings dis-
coverable are those in the muscles, tendons, etc.
It is impossible even to tell in which hemisphere of
the brain the motor cells reside.

There is another cogent argument against these
innervation-feelings. There is no conscious inner-
vation in reflex, automatic, and secondary-automatic
acts. The acts simply perform themselves in re-
sponse to the appropriate stimulus. In most cases
the innervation is altogether beyond the control of
the will. Yet the secondary-automatic acts were
at first voluntarily performed. If sentient inner-
vations exist, we must suppose them to have been
present when the movement was still voluntary.
But in some mysterious way they have relinquished
their function, and insentient innervations have re-
placed them. The existence of such a condition of
affairs seems improbable.

The import of the foregoing arguments is that the
motor current is not sentient, — that it is not felt
in the path of its discharge and that it is not felt at

MENTAL IMAGERY AND VOLUNTARY SPEECH 93

its source. It is impossible to suppose that the inner-
vation-current can be insentient, and yet be under
the control of the will. Consciousness cannot con-
trol that of which it is unable to take cognizance.
And if we suppose that the will is in any way able
to emit the motor current, we must concede that the
will is a physical force; whence we find ourselves
in conflict with the law of Conservation of Energy.
The attempt to compromise by supposing that the
will does not discharge the current, but merely con-
trols it, leads to the same dilemma: a force can be
controlled only by a force.

It is evident, then, that there can be no direct
control of the efferent current. Muscular movements
are controlled indirectly, — by attention to the results
they produce. The non-psychologist may find it
difficult to subscribe to this thesis, but his acceptance
or rejection of it need not affect his attitude toward
later discussions. If he holds that the discharge is
voluntary, he must admit that its purpose is foreseen.
To admit that the purpose is foreseen is to admit that
the nature of the act is determined by antecedent
mental images. Thus the image remains paramount,
whatever views be held on innervation. The hegem-
ony of the mental image may, then, be regarded as
established.

The subject of indirect control — through the
mental image — need not be discussed at length.

94 THE PSYCHOLOGY OF STAMMERING

Whatever views be held concerning the fiat — the
decision to act — the admission must still be made
that the mental imagery alone determines the nature of
tlie performance. With this point granted, we can
return to the subject of speech.

Our task is to ascertain the relative importance
of the kinaesthetic and auditory imagery in the initia-
tion of oral speech. It can be shown at the outset
that the kinassthetic centre can in some cases assume
the sole directive function in oral speech, just as it
can assume the sole direction of verbal thought.
In the congenitally deaf that have acquired the mas-
tery of language, speech must be evoked almost
exclusively by kinaesthetic cues. Some assistance
may be derived from visual images, but auditory
images are out of the question. In the case of the
deaf-blind Helen Keller, both visual and auditory
images are excluded, and speech is initiated ex-
clusively by images of feeling. Among persons not
deprived of any of the senses, we find a few that
have practically no auditory memory. It is evident
that they must resort to motor cues for the instiga-
tion of oral speech. Occasionally one of these "ar-
ticulo-moteurs " suffers an injury to the auditory
verbal centre, and whatever auditory images existed
are destroyed with the brain-cells. Yet verbal
thought and speech remain unimpaired. The patient

MENTAL IMAGERY AND VOLUNTARY SPEECH 95

is merely unable to interpret words that he hears. It
is evident, then, that oral speech can in some cases
be actuated exclusively by kinaesthetic images, the
auditory images being dispensable.

Taking the opposite aspect of the question : Can
the auditory images of themselves incite speech?
Apparently they can not, though there are several
facts that indicate the contrary if they are only
superficially examined. It will be well to consider
these facts carefully.

Children that are born deaf do not naturally learn
to speak.1 The usual inference is that the non-de-
velopment of speech is due to the absence of auditory
imagery. But speech can develop without auditory
imagery, and often when hearing is present the sense
is little more than a guide during actual enuncia-
tion. Hearing is important for the child while he
is acquiring speech, even though he be an articulo-
moteur; but in spite of this fact he may remember
words in terms of feeling and not in terms of hearing.
Thus the dumbness of a deaf child cannot be attrib-
uted to the lack of auditory images any more than
to the lack of kinaesthetic images. His dumbness is
due to the fact that he has not had hearing as a guide.

A child that loses his hearing at the age of five or

1 "Puppies, or even dogs, are rendered dumb by the destruction
of the internal ear." Waller, "Human Physiology," 3d ed., p. 550
(cites Danilewski).

96 THE PSYCHOLOGY OF STAMMERING

six gradually becomes dumb unless he is drilled in
articulation. The dumbness is frequently attributed
to the gradual disappearance of the auditory images.
The auditory images admittedly fade from conscious-
ness, but their disappearance is not necessarily the
cause of the muteness. Deafness is a mental cata-
clysm for the child ; it entails a sweeping change in
his psychic life. It would indeed be remarkable if
the child should evince a disposition to talk when
his own words have ceased to be audible to him. He
may attempt to speak, but his world of hearing has
been blotted out, and he does not even know whether
he is uttering sound or not. He probably believes
that his speech is affected as well as his hearing — if,
indeed, he is able to analyze the situation at all. The
fact that the child does retain possession of his speech
if he is carefully drilled in articulation is conclusive
evidence that acoustic images are dispensable for oral
speech, for it is generally admitted that privation of
hearing at an early age entails obliteration of the
auditory imagery.

There is another argument that is sometimes ad-
duced in favor of a purely auditory incitation of oral
speech. Occasionally a child gives utterance to
several consecutive words in his initial attempt at
speech. In such cases the development of speech is
usually delayed, and the child makes no use of lan-
guage till suddenly moved by some intense emotional

MENTAL IMAGERY AND VOLUNTARY SPEECH 97

excitement.1 The argument is that, since the child
has not previously spoken the words, he can have no
kinaesthetic memory of them. From this it is in-
ferred that the words are prompted solely by auditory
cues. However, in such cases the child usually in-
dulges freely in "baby-chatter" before he utters his
initial sentence, and in this way he establishes an
association between the feeling and the sound of the
syllables he utters. Many of the elementary sounds
are thus represented in both kinaesthetic and auditory
memory. Children usually learn language in this
piecemeal fashion, and they have undoubtedly both
kinaesthetic and auditory images of the elements of
speech they have mastered. Elements that are not
clearly represented in motor memory are mispro-
nounced; ultimately they are mastered by process
of trial and error. New words are learned by re-
combining the different elements, and since these
are represented in both kinaesthetic and auditory
memory, it is not necessary that a word should be
prompted at its first appearance by purely auditory
imagery. The articulo-moteur may turn to the
dictionary and read off hundreds of words that he
has never before pronounced, yet the words are
not initiated by auditory cues. He cannot even

1 In a case cited by Bastian the child did not speak till he was
five years of age. Then, upon breaking a toy, he suddenly ex-
claimed, "What a pity 1 "

98 THE PSYCHOLOGY OF STAMMERING

think the words in auditory imagery ; he finds that he
must mentally articulate them. This fact con-
clusively demonstrates that, when once the elements
of speech are mastered, any new combination of them
may be represented in kinaesthetic imagery prior to
its first enunciation.

Thus, the arguments in favor of a purely auditory
incitation are easily refuted. Those opposed to it
are conclusive.

If it were always possible for one to pronounce
words of which he has a clear auditory image ; then
the child should blossom into a fluent speaker as soon
as the neural speech-mechanism becomes functionally
mature.1 As soon as he speaks his first few words,
he should be able to pronounce any word that he is
able to think in auditory imagery. He should have
no difficulty in repeating any word that is spoken
to him, for the primary memory would be distinct,
even if no secondary memory were to endure. The
child should have no difficulty with his G's, K's, L's,
and 77?'s. He should be able to trill his R's, and
pronounce German gutturals and French nasals the
moment he hears them. We know, of course, that

1 "For it may fairly be said that the great majority of children
can remember the names given to many external objects when they
are four or five months old ; their memory in this respect continually
increasing through succeeding months, even whilst they still make no
very distinct efforts at articulating words for themselves." Bastian,
"The Brain as an Organ of Mind," p. 604.

MENTAL IMAGERY AND VOLUNTARY SPEECH 99

this is not the case, but that the child usually takes
years to master the elements of even his own language.
He proceeds by trial and error, and has no thorough
command of language till the kinaesthetic images of
speech are established.

Exactly the same argument applies in the case of
the adult to the mastering of foreign languages. If
speech-initiation could be accomplished by pure
auditory imagery, one should be able, as soon as the
auditory memory is established, to utter any sound
producible by the speech-organs. The primary
memory would be sufficient ; and one should be able
to repeat upon the demand the most difficult combina-
tions in Chinese, German, Swedish, or any other
language. The Englishman should be able to repeat
the uvular R the first time he hears it ; the German
should have no difficulty whatever with the English
Th. However, this is not the case. Few adults
can master even one foreign language and speak it
with a pure accent. As Kussmaul says : l

"No living person is able to pronounce the speech-sounds of
all the different races of the world. A Lepsius may express
them in writing, a Brttcke may discover the processes involved
in their articulation ; but even such scholars cannot articulate
them all. In the speech of every race only certain sounds
are developed, while other sounds are entirely neglected. Thus
there occurs a national and dialectical mogilalia."

1 "StSrungen der Sprache," 4th ed., p. 257.

ioo THE PSYCHOLOGY OF STAMMERING

Yet such difficulty with foreign languages would
never arise if auditory imagery were in itself sufficient
to incite oral speech. It is evident, then, that there
can be no pure auditory incitation of speech, but that
kinaesthetic images are also requisite. The audile,
then, becomes an audito-moteur when oral expression
is concerned.

The auditory image, nevertheless, plays a con-
spicuous r61e in the evocation of oral language. Any
impairment of the auditory brain-centre usually
induces a marked disturbance in speech. But the
auditory image never assumes exclusive control of
oral expression. This is proved by the fact that a
person invariably becomes mute if the motor memory-
centre is destroyed.

The auditory image is important in musical ex-
pression. There is with some persons an absolute
musical memory, — a musical memory that permits
them to produce a note of any desired pitch. It is
manifest that in such cases the auditory image must
be almost exclusively responsible for the note pro-
duced, for the note must be remembered as sound,
and not as feeling. Again, in singing and whistling,
the auditory image determines almost exclusively the
nature of the production. But even in singing, the
kinaesthetic image plays an important r61e. The
powerful articulations of a concert singer — or of one
that sings so that his audience can understand him

MENTAL IMAGERY AND VOLUNTARY SPEECH 101

— are produced more by images of muscular move-
ment than by images of sound.

Auditory imagery is an important factor — though,
again, never the sole factor — in mimetic performances.
Frequently the ear-minded person can give faithful
imitations of a brogue or a dialect, or he may be able
to imitate the timbre of another person's voice. He
is able to succeed because he mentally hears the sounds
he is about to utter. The articulo-moteur flounders
helplessly with the same task. He must experiment
with various conformations of the speech-organs ; and
if he finds one that gives the desired result, he must
remember it by feeling. Naturally enough, he meets
with little success as a mimic. But even the audito-
moteur depends upon his kinaesthetic imagery to a
great extent. He may not succeed hi imitating a voice
at the first attempt, but he succeeds after a little
practice. The practice, however, does not enhance
the vividness of the acoustic imagery; it merely
establishes an association between the auditory images
and the images of related articulative movements.
Mastering the pronunciation of foreign languages is
largely a matter of imitation; thus the audito-
moteur meets with greater success than the articulo-
moteur in this particular field.1

1 This fact does not refute the former argument concerning the
acquirement of foreign languages. The audile masters a foreign
language more readily because his auditory imagery assists him, —

102 THE PSYCHOLOGY OF STAMMERING

The import of the foregoing arguments is that the
average person, the audito-moteur, employs both
his resident and remote verbal images to incite oral
speech ; i.e. that he relies upon both his kinaesthetic
and auditory images of words. The kinaesthetic
image is a memory-image of the movements of the jaw
and lips and of the grosser movements of the tongue ;
and it is these movements that are prompted by
the motor memory. The more delicate speech-
movements — those producing fine differences in
vowel-coloration — undoubtedly occur, in all but the
articulo-moteur, in response to the auditory image of
the sound desired. The resident, or kinaesthetic,
image is in the latter case probably intercalated be-
tween the thought of the sound and its utterance;
but it is the remote sound-image, the image of the
vowel-color, that initiates the process.

With regard to the cerebral mechanism it is certain
that the kinaesthetic memory-centre acts directly
upon the executive motor centres. The only ques-
tion involved is whether the auditory centre is able
to act directly upon the executive motor centres or
only through the medium of the kinaesthetic centre.
Pathological cases indicate that the latter is the exist-
ing condition, but the matter cannot be said to be

not because the auditory imagery takes entire charge of the enun-
ciation. Without motor imagery, speech of any kind would be
impossible.

MENTAL IMAGERY AND VOLUNTARY SPEECH 103

definitely settled. In the case of the articulo-moteur
the motor mechanism is actuated exclusively from the
kinaesthetic memory-centre. A similar condition may
prevail with the audito-moteur ; but if such is the
case, the kinaesthetic images of the more subtle
lingual and laryngeal movements are aroused by the
auditory images through association. One fact is
established beyond all possibility of doubt, — that
with the audito-moteur the integrity of both the kin-
aesthetic verbal centre and the auditory verbal centre
is essential for oral speech. To express the matter in
terms of consciousness : there must be present in the
mind a mental image of the feeling of a word, and a
mental image of its sound.

If the feeling-image were a perfect representation
of the movements of speech, no sound-image would
be necessary. The sound-image supplements the
feeling-image where the latter is deficient; in other
words, its chief function is to supply the more delicate
movements that produce the vowel.

A word may be said at this point concerning the
speech of the orally taught deaf. The speech-cues
of the deaf are both kinaesthetic and articulatory-
visual ; the visual images, like the auditory images
with the normal person, being remote. Visual images
cannot incite speech directly, but it is probable that
with some deaf persons the primary revival of thought

104 THE PSYCHOLOGY OF STAMMERING

takes place in the visual centre, and that the visual
articulative images then arouse the images of feeling.
The process is analogous to the visile's seeing images of
printed words before he mentally hears and feels them.
The deaf person employs sight as a substitute for hear-
ing, and he interprets the spoken words of another
person by visually reading the lips, tongue, and facial
muscles. This visual appreciation of speech may be
complete before the pupil has gained thorough mas-
tery of his own speech-organs ; * hence it follows that
visual images are not in themselves sufficient for the
evocation of spoken language. The words must be
felt as well as seen. The delicate movements of the
larynx and pharynx, as well as many movements of
the tongue, are hidden from view ; and they must be
detected by feeling. It is this fact that so greatly
retards the pupil in the acquisition of oral speech.
Again, the difference between the surd and sonant
consonants must be felt rather than seen. One can-
not detect by sight the difference between B and P,
and D and T, for instance. When the deaf person
articulates these letters and such words as gain and
cane, and view and few, he feels the difference between
the surd and sonant consonants. The only difference

1 "In many oral classes a few of the scholars who are deficient
in their speech are able to follow their teacher's lips throughout the
course and keep as well to the fore as the others." Farrar, "Arnold
on the Education of the Deaf," p. 219.

MENTAL IMAGERY AND VOLUNTARY SPEECH 105

is in the point at which vocalization begins ; and this
difference makes no appeal to sight.

When the deaf pupil has mastered the art of speech,
he frequently interprets the words of other people
in terms of feeling:

"The deaf person, as he reads the face of another, mentally
converts what he sees into the organic action by which the
sound or sounds are produced ; so much so that he often repeats
to himself what he sees the other saying." 1

These facts show that the kinaesthetic images are
in the deaf at least as conspicuous as those of sight.
In speech, the visual image is undoubtedly remote;
its function is that of arousing the kinaesthetic image
by association rather than that of acting directly
upon the executive motor centres.

1 "Arnold on the Education of the Deaf," p. 217.

CHAPTER VI

IMPAIRMENT OF THE BRAIN-CENTRES: APHASIA

A PERSON suffering a lesion in one of the memory-
centres incurs obliteration or impairment of the cor-
responding mental imagery. A lesion in the left
occipital lobe destroys the images of sight. Damage
to the angular gyrus effaces the visual images of
printed or written words. An injury to the first
temporal convolution destroys the auditory memory
of words; while an injury to the posterior portion
of the third frontal convolution destroys the kin-
aesthetic verbal memory.

The lesion must, of course, occur in the memory-
hemisphere of the brain; that is, in the left hemi-
sphere in right-handed persons, and the right hemi-
sphere in left-handed persons. When it occurs in
the other hemisphere, the intellectual life remains
practically unaffected. When there is degeneration
of the cortex rather than absolute destruction of the
cells, the patient is still able to interpret sensations,
though he is unable voluntarily to redintegrate the
mental images. The inability to arouse mental
images is called amnesia. The inability to interpret

106

APHASIA 107

sensations is called mind-blindness, mind-deafness,
etc., according to the nature of the malady. This
psychic blindness or deafness usually involves its cor-
responding form of amnesia, but the amnesia does not
necessarily involve the inability to interpret sensa-
tions.

Aphasia is a generic term applied to these different
forms of cerebral defects. It is applied more partic-
ularly to the cerebral disturbances of speech.

The significance of the loss of a particular type of
mental imagery is determined entirely by the promi-
nence of the imagery in thought. Deprivation of the
visual imagery would be a calamity for an eye-minded
person. Loss of the auditory imagery would be dis-
astrous to an ear-minded person. But it is safe to
say that few people would be inconvenienced by dis-
possession of their images of taste and smell, for these
images have little significance for the intellectual
life. General intelligence would suffer little from the
loss of the musical memory; but such a loss would
be calamitous for a composer or a musician. With
many persons there is congenital olfactory, gustatory,
or musical amnesia; more rarely there is congenital
auditory or visual amnesia. In such cases an injury
to the torpid brain-centre would have no effect upon
memory. If the injury were profound, it would
interfere with perception, but the concepts would
remain virtually unaffected.

io8 THE PSYCHOLOGY OF STAMMERING

VISUAL AMNESIA AND OBJECT-BLINDNESS

A lesion in the visual memory-centre (G. V. C.t
Figure 5) effaces the memory for visual experiences.
If the degeneration of the cells is slight, the resultant
disturbance may be merely visual amnesia, — in-
ability to arouse the visual images. When destruc-
tion of the cells is complete, there is object-blindness
in addition, and the patient no longer recognizes
things that he sees. So long as the primary visual
centres are unimpaired, the patient sees as well as
ever. But he does not interpret his visual sensations ;
the world, as he meets it through sight, is as strange
and incomprehensible to him as to a new-born child.
He does not recognize a chair as a chair, nor a book
as a book. He does not recognize his surroundings ;
and if the attack occurs suddenly, he may wander
in the streets imagining that he is lost. He may
refuse to enter his own home, declaring that the house
is unfamiliar. He repudiates his friends, and in
general conveys the impression that he is demented.
Indeed, if he has no knowledge of the normal workings
of his mind, he may himself imagine that he has be-
come insane. A visile that becomes subject to such
a malady has the most effective part of his mind
blotted out. His intelligence is reduced in propor-
tion as visual imagery formerly predominated in his
thinking.

APHASIA 109

One of Bernheim's1 patients was shown a brush,
but he failed to recognize or name it.

"Of what use is it ? " he was asked.

"It is used for walking," he replied; and when
asked for a demonstration he proceeded to make the
brush take steps. Later he exclaimed, "No, it is
used for making strokes. No!" ("Non, c'est pour
faire des barres. Non !") Then after a few minutes
he finally recognized it: "It is used to brush with;
it is a brush."

James 2 gives the following account of one of
Charcot's patients that was suffering from visual
amnesia and a marked degree of object-blindness:

"The patient was Mr. X., a merchant, born in Vienna,
highly educated, master of German, Spanish, French, Greek,
and Latin. Up to the beginning of the malady which took him
to Professor Charcot, he read Homer at sight. He could, start-
ing from any verse out of the first book of the Iliad, repeat the
following verses without hesitating, by heart. Virgil and
Horace were familiar. He also knew enough of modern Greek
for business purposes. Up to within a year (from the time
Charcot saw him) he enjoyed an exceptional visual memory.
He no sooner thought of persons or things, but features, forms,
and colors arose with the same clearness, sharpness, and ac-
curacy as if the objects stood before him. When he tried to
recall a fact or a figure in his voluminous polyglot correspond-

1 Rev. de mid,., 1885. Quoted by Bastian, "Aphasia and Other
Speech Defects," p. 212.

'"Principles of Psychology," Vol. II, pp. 58 ff. The original
account appears in Progres Medical, 21 juillct, 1883.

no THE PSYCHOLOGY OF STAMMERING

ence, the letters themselves appeared before him with their
entire content, irregularities, erasures, and all. At school he
recited from a mentally seen page which he read off line by
line and letter by letter. In making computations, he ran his
mental eye down imaginary columns of figures, and performed
in this way the most varied operations of arithmetic. He could
never think of a passage in a play without the entire scene,
stage, actors, audience, appearing to him. He had been a great
traveller. Being a good draughtsman, he used to sketch views
which pleased him ; and his memory always brought back the
entire landscape exactly. If he thought of a conversation, a
saying, an engagement, the place, the people, the entire scene
rose before his mind.

"His auditory memory was always deficient, or at least
secondary. He had no taste for music.

"A year and a half previous to examination, after business
anxieties, loss of sleep, appetite, etc., he noticed suddenly one
day an extraordinary change in himself. After complete con-
fusion, there came a violent contrast between his old and his
new state. Everything about him seemed so new and foreign
that at first he thought he must be going mad. He was ner-
vous and irritable. Although he saw all things distinct, he had
entirely lost his memory for forms and colors. On ascertain-
ing this, he became reassured as to his sanity. He soon dis-
covered that he could carry on his affairs by using his memory
in an altogether new way. He can now describe clearly the
difference between his two conditions.

"Every time he returns to A., from which place business
often calls him, he seems to himself as if entering a strange
city. He views the monuments, hous. 3, and streets with the
same surprise as if he saw them for the first time. Gradually,
however, his memory returns, and he finds himself at home
again. When asked to describe the principal public place of

APHASIA in

the town, he answered, ' I know that it is there, but it is im-
possible to imagine it, and I can tell you nothing about it.'
He has often drawn the port of A. To-day he vainly tries to
trace its principal outlines. Asked to draw a minaret, he re-
flects, says it is a square tower, and draws, rudely, four lines,
one for ground, one for top, and two for sides. Asked to draw
an arcade, he says, 'I remember that it contains semicircular
arches, and that two of them meeting at an angle make a vault,
but how it looks I am absolutely unable to imagine.' The
profile of a man which he drew by request was as if drawn by
a little child ; and yet he confessed that he had been helped to
draw it by looking at the bystanders. Similarly he drew a
shapeless scribble for a tree.

"He can no more remember his wife's and children's faces
than he can remember the port of A. Even after being with
them for some tune they seem unusual to him. He forgets
his own face, and once spoke to his image in a mirror, taking it
for a stranger. He complains of his loss of feeling for colors.
' My wife has black hair, this I know ; but I can no more recall
its color than I can her person and features.' This visual am-
nesia extends to dating objects from his childhood's years —
paternal mansion, etc., forgotten.

"No other disturbances but this loss of visual images. Now
when he seeks something in his correspondence, he must rum-
mage among the letters like other men, until he meets the pas-
sage. He can recall only the first few verses of the Iliad, and
must grope to read Homer, Virgil, and Horace. Figures
which he adds he must now whisper to himself. He realizes
clearly that he must help his memory out with auditory images,
which he does with effort. The words and expressions which
he recalls seem now to echo in his ear, an altogether novel sen-
sation for him. If he wishes to learn by heart anything, a
series of phrases for example, he must read them several times

112 THE PSYCHOLOGY OF STAMMERING

aloud, so as to impress his ear. When later he repeats the thing
in question, the sensation of inward hearing which precedes
articulation rises up in his mind. This feeling was formerly
unknown to him. He speaks French fluently, but affirms that
he can no longer think in French; but must get his French
words by translating them from Spanish or German, the lan-
guages of his childhood. He dreams no more in visual terms,
but only in words, usually Spanish words. A certain degree
of verbal blindness affects him — he is troubled by the Greek
alphabet, etc."

With an ear-minded person a corresponding cere-
bral lesion would have resulted less seriously. The
visual images would, of course, have been obliterated ;
but their loss would not have been so grave a matter
for a person living in a world of sounds. Conversely,
the loss of the auditory images would have been a
matter of little moment for the patient in question,
for so long as the verbal imagery were not affected,
the intellectual faculties would have been little
impaired.

Defects of the visual memory are often associated
with homonymous hemianopsia, — obliteration of one
half of the visual field. This is due to the invasion,
by the degenerative process, of the primary visual
area in the cuneate lobule and its immediate neigh-
borhood. The condition is one of physical blindness.
It is anomalous only in the fact that it affects but one-
half of the field of vision. If lesions occur in both
cuneate lobules, the condition differs in no way from

APHASIA 113

ordinary physical blindness. When the lesion is lim-
ited to the primary visual area, there is no impairment
of the visual memory-images.

VISUAL VERBAL AMNESIA, WORD-BLINDNESS, AND
AGRAPHIA

A lesion in the angular gyrus (V. V. in Figure 5)
annihilates the visual images of printed and written
words. A superficial injury may entail merely the
inability to redintegrate the visual images spon-
taneously. In this case there is visual verbal amnesia
with agraphia — the inability to write. The patient
cannot write because he is unable to recall the appear-
ance of the word he wishes to pen. When the in-
jury is profound, the patient is unable to recognize
words that he sees, and the resulting condition is one
of word-blindness 1 in addition to the visual verbal
amnesia and agraphia. The patient occasionally
retains his memory for letters and figures. This is
accounted for by the fact that letters and figures are
learned first and are consequently more deeply seated.
In many instances the explanation is probably the
existence of number-forms subserved by the general
visual centre rather than the visual verbal centre.

The word-blind patient understands all that is said
to him, and thinks clearly in words so long as the
auditory centre is not affected. His difficulty is

1 Word-blindness is sometimes called alexia.

H4 THE PSYCHOLOGY OF STAMMERING

merely in interpreting printed or written words. He
sees the words in front of him, but they convey no
more meaning than they would if they were upside-
down, or were written in a foreign language.

The agraphia is not always complete. The patient
often retains the ability to write his own signature,
and perhaps a few short words or letters. These are
probably revived in kinaesthetic imagery, — the pa-
tient writing by feeling. He can copy writing that is
put before him, but he does not do so understandingly.
He copies print in print, and script in script, writing
like a forger that copies an inverted signature.
Occasionally the word-blind person manages to divine
the meaning of a written word by tracing it with
his finger. In this case, when the angular gyrus is
damaged, he interprets the word entirely by feeling.
In attempting to write, the patient may produce
a jumble of letters, likewise by feeling. This per-
version of the faculty of writing is called paragraphia.

The following is a typical case of word-blindness,
visual verbal amnesia, and agraphia, resulting from
damage to the angular gyrus : l

"A female, aged 63, admitted into the Asylum of Villejuif
on the 2gth of Sept., 1891. Was intelligent, but had lost the
power of reading and writing. Being anxious to regain the

1 Wyllie, "Disorders of Speech," pp. 349 f. Case reported by
SSrieux, Comptes rendus des stances de la Socittt de Biologie, Jan-
vier, 1892.

APHASIA 115

power of reading and writing, she practised much with her
pen ; but her efforts resulted only in such confused collections
of letters as the following — these being, moreover, written
badly — in a tremulous hand — ' an um aa monon mono muosil '
The intelligence was normal, and there were no paralytic symp-
toms whatever. Vision was intact, and it is expressly stated
that there was no hemianopsia. It was as impossible for the
patient to read as to write. She could, however, recognize a
few of the individual letters ; and when a word was composed
of these she could sometimes spell it out and pronounce it."

At the autopsy there was found a softening in the
angular, gyrus and supra-marginal convolution, i.e.
in the visual verbal area.

Word-blindness, strangely enough, does not always
entail visual verbal amnesia. If the word-blindness
were invariably due to destruction of the angular
gyrus, amnesia would be an inevitable concomitant.
However, it is sometimes induced by a subcortical
lesion severing the visual memory-centre from the
primary visual area. The consequence is that the
visual sensation is unable to arouse the visual memory-
image; thus no perception can take place. But so
long as the cortical cells in the angular gyrus are un-
affected, the visual images of words remain unim-
paired. The patient writes spontaneously or from
dictation with the greatest ease, exciting the graphic-
motor centre from the visual verbal centre. But
he cannot read the words that he has written, for the
excitation in the primary visual area is unable to

n6 THE PSYCHOLOGY OF STAMMERING

reach the visual memory-centre. Occasionally the
patient can interpret writing by tracing the words
with a pen or with his finger. In this case the vis-
ual memory-images are aroused by the kinaesthetic
impressions.

The following is a fairly typical case of subcortical
word-blindness : *

"The patient was a man aged 68. After a number of attacks
of tingling in the right leg and arm, he suddenly perceived that
he could not read a single word ; but he still retained the power
of writing, and indeed could write with perfect ease. For
four years he remained in this condition — totally word- and
even letter-blind, but able to write correctly whole pages of
manuscript though quite unable to read them after they were
written. He had also lost the power of reading musical notes,
though he could still sing well. He retained the power of
reading figures, and could do mental calculations as well as
formerly. He had right homonymous hemianopsia.

" Ten days before his death, he became suddenly affected
with very pronounced paraphasia, and with total agraphia;
without, however, any paralysis of motion or loss of conscious-
ness. There was no trace of word-deafness ; and he retained
his intelligence to the end."

At the autopsy there was found an old lesion that
destroyed the primary visual area in the left hemi-
sphere (this accounting for the right homonymous
hemianopsia) and the commissural fibres uniting the

1Wyllie, "Disorders of speech," pp. 339 f. Case reported by
Ddjerine, Comptes rendus des stances de la Soctitt de Biologic, mars,
1892.

APHASIA 117

angular gyms with the primary visual area of the
right hemisphere. Thus the patient was blind in
one-half of the field of vision ; while impressions from
the other half were unable to reach the memory-centre.
These facts explain the word-blindness. The in-
tegrity of the angular gyms explains the absence of
agraphia. A recent lesion in the angular and supra-
marginal convolutions accounted for the disturb-
ances that occurred just previous to death.

A similar case is recorded by Ballet,1 but he inter-
prets his case somewhat differently. He supposes
the patient to have suffered an injury to the angular
gyrus, thus incurring obliteration of the visual images
of words. In the absence of autopsical examination
it is, of course, impossible to determine exactly what
happened. There was right homonymous hemianop-
sia, so it is probable that the injury was similar to
that in the preceding case. The patient was able to
write. Ballet supposes that he relied upon his graphic-
motor images. Such a condition would be possible
in the motile, especially if he mentally spelled each
word and wrote the letters as he mentally pronounced
them. It is scarcely conceivable that even the motile
should write long words by feeling, without assistance
from other forms of verbal imagery. Ballet's ex-
planation is not an impossible, though it seems an
improbable, one.

1 "Le langage intlrieur et 1'aphasie," 2d ed., pp. 104 ff.

n8 THE PSYCHOLOGY OF STAMMERING

There seem to be no cases of pure agraphia on record.
Agraphia does occur without word-blindness, but it
is usually complicated by paresis or cutaneous an-
aesthesia, and the patient is physically unable to
write. The presence of paresis is accounted for by
the proximity of the executive motor centres to
the kinaesthetic memory-centres. In many cases
agraphia is accompanied by motor or auditory
aphasia, and the inability to write may be due to
the obliteration of internal language.

Ballet l records a curious case of kinaesthetic amnesia
that came under the observation of Charcot. The
patient had lost his ability to play the trombone.
He "had lost the memory of the associated movements
of the mouth and hand required for playing the in-
strument. All the other motor memories were intact.
This musician had forgotten the manipulation of the
trombone, just as others forget the manipulation of
the pen."

APHEMIA

We come now to the consideration of cerebral dis-
turbances that more directly affect the faculty of oral
speech. Aphemia, being the simplest disorder, will
be considered first. Aphemia is a disturbance of
speech due to lesion of the purely executive motor
mechanism. The seat of the lesion may be the
cortical motor centre at the foot of the precentral

1 Loc. tit., p. 134.

APHASIA 119

convolution, or the bulbar motor centres, or some
point in the efferent tracts. The aphemia usually
manifests itself in complete mutism. There is, how-
ever, no disturbance of internal language, — either
visual, auditory, or kinaesthetic. There is no word-
deafness or word-blindness.

The absence of word-deafness is easily demonstrated
by the readiness with which the patient obeys orally
imparted instructions. If he is told to take out his
watch and wind it, or to take a book and open it at
a certain page, he immediately obeys. Absence of
word-blindness is shown by the patient's ability to
comply with written instructions. Absence of amnesia
is not so readily determined, for the patient may
respond to external impressions and yet be unable to
arouse the mental images spontaneously. Disturb-
ances in the motor centre are very frequently accom-
panied by hemiplegia, — unilateral paralysis. This
is due to the fact that the lesion is seldom limited to
the mechanism concerned with speech, but invades
other regions as well. When hemiplegia is present,
the patient has great difficulty in expressing himself
in writing. However, by using the left hand he can
express, in a somewhat labored way, thoughts that
occur to him spontaneously. This ability shows that
he is able to think in verbal imagery. His ability
to perform arithmetical problems, etc., also shows
that internal language is unimpaired. The Proust-

120 THE PSYCHOLOGY OF STAMMERING

Lichtheim test is often applied to ascertain the
condition of the patient's internal language. If the
patient's verbal thought is unaffected, he is able to
indicate the number of syllables in a word, — the
name of an object shown to him, for instance. This
he does by making expiratory efforts, by pressing
his interlocutor's hand, by tapping on the table, etc.
In like manner he indicates the number of letters in
a word; thus demonstrating his ability to spell the
word mentally.

The ability of the patient to indicate the number of
syllables in a word is regarded by some pathologists
as evidence of the retention of the kinaesthetic verbal
images. The ability to comply with the test is proof
of the existence of some form of verbal imagery, but
it does not seem to follow that the imagery must
necessarily contain the kinsesthetic element. If the
audile were able to make the words resound in his
mind syllable by syllable, he could certainly comply
with the conditions of the test. In the audile it
would be scarcely possible to differentiate pure aphe-
mia from loss of the kinaesthetic memory of words.

Doctor Samuel Johnson thus describes, in a letter
to Mrs. Thrale, a temporary attack of aphemia that
befell him in his seventy-fourth year:

"On Monday, the i6th, I sat for my picture, and walked a
considerable way with little inconvenience. In the afternoon
and evening, I felt myself light and easy, and began to plan

APHASIA 121

schemes of life. Thus I went to bed, and in a short time waked
and sat up, as has long been my custom, when I felt a confusion
and indistinctness in my head, which lasted I suppose about
half a minute. I was alarmed and prayed God that, however
He might afflict my body, He would spare my understanding.
This prayer, that I might try the integrity of my faculties,
I made in Latin verse. The lines were not very good, but I
knew them not to be very good ; I made them easily and con-
cluded myself to be unimpaired in my faculties." 1

This attack of aphemia proved to be temporary.

The following is a case reported by Dejerine.2
The patient, an accountant, had become speechless
after an apoplectic attack.

"He understands readily all questions addressed to him,
either orally or by writing. He recognizes all external objects.
Cannot utter aloud a single word either spontaneously, by read-
ing, repeating, or singing. But he can indicate the number of
syllables in the words he wishes to utter, by so many expiratory
efforts or pressures with the fingers. By bringing one's ear
quite close to his mouth one can distinguish certain words pro-
nounced in an excessively low voice — less than a whisper.
Some of these words are not pronounced correctly, the articu-
lation of the labials being especially interfered with — the b
being pronounced like an m. And the same mistakes occur
when he attempts to read or repeat a phrase as when attempt-
ing to utter them spontaneously. . . . The right hemiplegia
being slight, the patient can make use of a pen, and writes
either spontaneously, from dictation, or in copying. This he
does fairly legibly and with no mistakes."

1 Quoted by Bastian, " Aphasia and Other Speech Defects,"
p. 66. * Quoted by Bastian, loc. cit., p. 70.

122 THE PSYCHOLOGY OF STAMMERING

At the necropsy there were found three small foci
of softening : one beneath the lower extremity of the
fissure of Rolando, one beneath the posterior ex-
tremity of the third frontal convolution, and one be-
neath the foot of the precentral convolution. Either
of these last two lesions might have caused the aphe-
mia. The one beneath the kinaesthetic memory-centre
would have isolated the image-centres from the motor
region. The one at the foot of the precentral con-
volution would have interfered with the Remission of
the motor current.

ARTICULATORY-KIN^STHETIC APHASIA

Articulatory-kincBsthetic aphasia, or motor aphasia,
is due to the total or partial obliteration of the kin-
aesthetic images of articulatory movements. It is
caused by lesion of the posterior part of the third
frontal convolution of the left hemisphere (K. V. in
Figure 5). Motor aphasia is usually associated with
right hemiplegia, this being due to the extension
of the lesion into the true motor area of the brain.
Strictly delimited lesions do not induce hemiplegia.
The onset of the malady is usually abrupt ; and if the
lesion is extensive, the patient is speechless from the
beginning. If the patient is an audile, there is no
verbal amnesia so long as the auditory area is un-
affected. The patient has clear acoustic images of
words, but is unable to translate them into kinaes-

APHASIA 123

thetic images in order that he may express them. He
is in the position of a man that can recall orchestral
music, but has no means of externalizing his acoustic
thoughts. If the patient is an articulo-moteur, in-
ternal language is annihilated. Since the average
person is an audito-moteur, there is usually con-
siderable amnesia. Patients with motor aphasia
interpret spoken language with varying degrees of
facility. At the beginning of the attack there is
frequently considerable word-deafness owing to the
inability of the acoustic impressions to arouse their
kinaesthetic associates.

The following is a case of aphasia due to the partial
destruction of the kinaesthetic memory-centre. The
case is reported by Collins.1

" Mrs. X — , a widow, sixty-three years old, the mother of
eight children, has had a vigorous, active life, free from ill
health, save that twelve years ago she suffered severely from
attacks of renal calculi. During the past year or two she has
complained of indigestion and more recently of a dull, aching
sensation in the back of the head and neck, with occasional
attacks of very severe pain in the left temple. For a few weeks
previous to the beginning of her present symptoms she suffered
from insomnia, from irritability, nervousness, and forgetful-
ness. Her son, a physician, gives the following account of
the onset of her aphasic symptoms. One week before consult-
ing me she discovered, while making a call, that her speech had
become, without warning, very much embarrassed. She could
not finish the sentence she had started to speak. She forgot

1 "The Faculty of Speech," pp. 422 ff.

124 THE PSYCHOLOGY OF STAMMERING

what she wanted to say. She chafed under this impotence and
got very much excited. She returned home in a street car, and
was much astonished to discover on looking at the signs with
which the cars are lined that she was quite unable to compre-
hend their signification. She could see the letters and words,
she knew that they were letters and words, but they conveyed
no meaning to her. When she got home she tried to tell her
family about her disability, but was able to say only a few words,
and these were entirely disconnected. After trying to speak
for a time she became excited and began to cry. On the follow-
ing day when she awakened, she could say only 'Yes' and
'No,' but as the day wore on her vocabulary became somewhat
larger. It was particularly remarked that when she was ex-
cited or very emotional sometimes words would flow out of her
mouth in an astonishing manner. From that tune until I
saw her there had not been very much change in her capacity
for speech production.

"The following is a stenographic report of the examination
to determine the disorder of voluntary speech. In response
to the question to tell me all that she could concerning the onset
and course of her symptoms, she said :

"'Well, mem-mem — three weeks, m-m-em — feel-m-em-
em — sometimes [prolonged pause, seems to be thinking]
couldn't thought — no thought — forget — but — eh — last
Friday [another prolonged pause] am — no — noticed they —
I couldn't — eh — I [prolonged pause] I couldn't tell, am, I,
don't, I can't, can't express [explosively] I can't tell — I can-
not [points to her head and looks weary]. It seems, I can't,
last Monday, con-con-nects — sentence, two or three words —
gone. Was — gone, blank, didn't know. Can't think, was
gone, forget — forget everything. Couldn't, couldn't, can't.'

"To test her capacity to repeat, I asked her to say after me :
'I stood on the bridge at midnight.' Her reply was:

APHASIA 125

'"I stood — the — night,' said with great effort, and with
apparent endeavor to repeat each word as quickly as they fell
from my lips.

'"Still sits the schoolhouse by the road ? '

" 'Forget — yes — the — the — s's's' forget — road.' "

The patient's internal language was probably as
defective as her speech. She indicated her inability
to repeat inwardly the Lord's Prayer, and she was
unable to write either spontaneously or from dicta-
tion. She understood fairly well what was said to
her; hence the auditory centre could not have been
destroyed. Destruction of the kinaesthetic centre was
incomplete ; otherwise the patient would have been
mute.

Destruction of Broca's convolution does not neces-
sarily entail obliteration of internal language. If the
patient happens to be an audile, there may be no amne-
sia verbalis whatever. In fact, the case does not then
differ in its symptoms from one of pure aphemia. In
the following case of articulatory-kinaesthetic aphasia
(recorded by Guido Banti) the patient was mani-
festly an audile, and he thought in auditory verbal
images after the kinaesthetic images had been ex-
punged : :

1 Bastian, "Aphasia and Other Speech Defects," p. 89. Case re-
ported by Guido Banti in "Afasia e sue Forme, Lo Sperimental,"
1886, LVII, obs. II, p. 270, and quoted by Prdvost in the Revue
mtdicale de la Suisse Romande, June 30, 1895.

126 THE PSYCHOLOGY OF STAMMERING

"A right-handed man, aged 36, who was able to read and
write correctly, had a sudden apoplectic attack in 1877. Re-
covering consciousness in a few minutes he was found to be
suffering from right hemiplegia and loss of speech. The paraly-
sis of the limbs disappeared almost completely during the
following night, though the inability to speak persisted.

"The next day he was admitted into hospital, and on most
careful examination his condition was found by Guido Banti
to be as follows:

"'The motility of the limbs on the right side had returned
to their normal condition. There was no trace of paralysis
of the face or of the tongue. The patient made ineffectual
attempts to speak ; he could not articulate a single word, not
even isolated syllables. He was much affected by this mutism,
and sought to make himself understood by gestures. I asked
him if he knew how to write, and after he had made a gesture in
the affirmative I gave him what was necessary and told him to
write his name, which he did immediately. I put various other
questions to him, to which he replied similarly by writing. I
told him to give me a description of his illness, and he wrote
without hesitation the details above reported. I showed him
various objects, pieces of money, etc., telling him to write their
names, and he did so without making any mistakes. Then
instead of giving him these directions by word of mouth, I
wrote them for him in order to thoroughly convince myself
that he was able to understand writing. He replied to these
questions with perfect correctness. He always wrote very
rapidly and did not seem to hesitate to choose his words. He
made no mistakes in syntax or orthography. He could under-
stand equally well ordinary writing and print, and when one
spoke to him he grasped at once the meaning of the questions,
and never wished to have them repeated. I next wrote some
most simple words such as "pain," "vin," etc., and urged him

APHASIA 127

ineffectually to read them aloud. I then pronounced myself
some of the words, directing him to repeat them. He appeared
to watch with great attention the movements of my lips whilst
I spoke ; he made some ineffectual efforts to obey, but he
never succeeded in pronouncing a single word.'

"This patient died in February, 1882, from an aneurism
of the aorta ; and a patch of yellow softening was found situated
in the posterior third of the third left frontal convolution, and
extending for some millimetres only into the white substance."

It will be seen that the kinaesthetic memory-centre
was completely destroyed.

If the patient had happened to be an articulo-
moteur, there would undoubtedly have been com-
plete verbal amnesia. Taking another point of view
-if the lesion had occurred with this patient in
the first temporal convolution, the auditory images
of words would have been blotted out, and the
patient would probably have been incapable of
verbal thought.

The two following cases show clearly the different
consequences that an affection of Broca's centre may
entail. Both cases exhibit jargon-aphasia; but in
one, internal language remained intact, while in the
other it was distorted.

The first is one of Dr. Osborn's cases, quoted by
Bastian in "The Brain as an Organ of Mind." 1

1 "The Brain as an Organ of Mind," pp. 667 ff. Dr. Osborn's
account appears in the Dublin Journal of Medical and Chemical
Science, Vol. IV, p. 157.

128 THE PSYCHOLOGY OF STAMMERING

"A scholar of Trinity College, Dublin, twenty-six years of
age, of very considerable literary attainments, and well versed
in French, Italian, and German, whilst sitting at breakfast,
after having bathed in a neighboring lake, suddenly had an
apoplectic fit. He was reported to have become 'sensible in
about a fortnight,' but, although restored to the use of his in-
tellect, he had the mortification of finding himself deprived of
speech. He spoke, but what he said was quite unintelligible,
although he labored under no paralytic affliction and uttered
a variety of syllables with the greatest apparent ease. When
he came to Dublin his extraordinary jargon led to his being
treated as a foreigner hi the hotel where he stopped ; and when
he went to the college to see a friend he was unable to express
his wish to the gate porter, and succeeded only by pointing to
the apartments which his friend had occupied.

"Dr. Osborn, after frequent careful investigations, ascer-
tained the following particulars concerning his patient : —

"i. He perfectly comprehended every word said to him.

"2. He perfectly comprehended printed language. He
continued to read a newspaper every day ; and when examined
proved that he had a clear recollection of all that he read.
Having procured a copy of Andral's 'Pathology' in French
he read it with great diligence, having lately intended to em-
brace the medical profession.

"3. He expressed his ideas in writing with considerable
fluency; and when he failed it appeared to arise merely from
confusion, and not from inability, the words being orthographi-
cally correct, but sometimes not in their proper places.

"4. His general mental power seemed unimpaired. He
wrote correctly answers to historical questions ; he translated
Latin sentences accurately ; he added and subtracted numbers
of different denominations with uncommon readiness ; he also
played well at the game of draughts.

APHASIA 129

"5. His power of repeating words after another person
was almost confined to certain monosyllables ; and in repeating
the letters of the alphabet he could never pronounce k, q, u,
v, w, x, and z, although he often uttered these sounds in attempt-
ing to pronounce the other letters. The letter i, also, he was
very seldom able to pronounce.

"6. In order to ascertain and place on record the peculiar
imperfection of language which he exhibited, Dr. Osborn selected
and laid before him the following sentence from the bye-laws
of the College of Physicians, viz. 'It shall be in the power of the
College to examine or not examine any Licentiate previous to his
admission to a Fellowship, as they shall think Jit.'

"Having set him to read, he read as follows: — 'An the be
what in the temother of the trothotodoo to majorum or that emi-
drate eni enikrastrai mestreit to ketra totombreidei to ra fromtreido
as that kekritest.' The same passage was presented to him a
few days afterwards and he then read it as follows: — 'Be
mother be in the kondreit of the compestret to samtreis amtreit
emtreido and temtreido mestreUerso to his eftreido turn bried re-
deriso of deid daf drit des trest.'

"He generally knew that he spoke incorrectly, although he
was quite unable to remedy the defect."

It is easy to show that the defective speech was
due to some perversion of function in the kinaesthetic
verbal centre (K. V. in Figure 5). The patient had
full possession of internal language; hence one of
the verbal memory-centres must have been intact.
It could not have been the kinaesthetic centre, for
if this had been intact, the patient would have had
no difficulty in oral expression. It is evident that
the kinaesthetic centre was damaged. If the auditory

130 THE PSYCHOLOGY OF STAMMERING

centre (instead of the kinaesthetic centre) had been
damaged, the patient would have had less difficulty
in repeating spoken language, for the cerebral dis-
turbance was manifestly of an incipient nature. With
incipient softening or a functional disturbance in the
kinaesthetic centre, and with the patient an audile,
one would expect the very symptoms that prevailed,
— retention of internal language and manifestation
of jargon-aphasia.

In the second case there was distortion of the verbal
imagery. The case is one of transitory aphasia that
befell the writer less than a year ago, — giving him
a valuable insight into the subjective aspect of aphasia.
As in the case just described, the disturbance was in-
duced by exposure to cold.

The writer was in the Rocky Mountains, crossing
a pass at an elevation of 12,000 feet. A violent
storm prevailed. There was heavy rain, and a freez-
ing wind against which it was difficult to stand. The
writer attempted to communicate with another mem-
ber of the party, and found to his astonishment that
his language was completely unintelligible. It was,
in fact, the meaningless jargon of aphasia. For a
moment the disturbance was thought to be due to
a benumbed condition of the articulative organs ; but
this belief was quickly dispelled. As soon as the
nature of the disturbance was recognized, the writer
undertook an introspective analysis of the mental

APHASIA 131

condition. The results would naturally be more
valuable if it had been possible to anticipate the in-
cident and plan the analysis beforehand. As it
was, the introspection was improvised under con-
ditions of physical and mental distress attendant
upon exposure to cold; and many valuable points
that might otherwise have been examined were over-
looked. Nevertheless, the results are interesting and
instructive.

In the first place, there was no knowledge of the
aphasic condition till the attempt was made to speak.
The thought-processes had not been in any way em-
barrassed. The sound of the wind and rain was
clearly interpreted, and all visual and tactual impres-
sions carried their proper import. Verbal communi-
cations from other members of the party were clearly
understood. In short, the perceptual and conceptual
processes seemed normal ; and it is doubtful whether
the aphasic condition would have been noticed if no
occasion for speech had arisen. (This seems all the
more likely since the aphasia disappeared soon after
a more protected part of the mountains was reached.
This occurred ten or fifteen minutes after the disturb-
ance was first noticed ; and as the thought-processes
had not been thoroughly introspected, the writer re-
turned — with more zeal than wisdom — to an exposed
position in the pass in order to restore the conditions
for the analysis. The aphasia thereupon returned.)

132 THE PSYCHOLOGY OF STAMMERING

In regard to speech, it was noticed that articu-
lation was somewhat labored and spasmodic ; but there
was no similitude between the sounds uttered and
those appropriate for the expression of the thought
Initial consonants, vowels, and final consonants were
jumbled promiscuously, and more than half the words
were distorted beyond recognition. Here and there
a word was intact, and occasionally only one con-
sonant in a word would be mutilated. The writer
could tell immediately whether or not the sounds
uttered were appropriate. If a word happened to be
pronounced correctly, or was only partly distorted,
the fact was immediately recognized.

Introspection showed that verbal thought was an
exact counterpart of speech. There occurred the
same jumble and confusion in the verbal imagery, and
it was impossible to express a thought clearly in in-
ternal language. When an attempt was made to
translate a visual thought into mental words, nothing
resulted but mental gibberish.

As stated, there was, however, no discernible im-
pairment of intelligence. Even abstract thought
seemed unaffected, and thoughts were clearly form-
ulated in the mind, although they could not be ex-
pressed in mental speech. These thoughts were
conducted chiefly in visual and motor imagery.

The visual images were normal and could be redin-
tegrated at will. Visual images of different scenes,

APHASIA 133

faces, etc., were recalled with normal facility.
Thoughts expressed themselves spontaneously in
images of sight. In many cases these visual thoughts
were saved from oblivion only by a sudden chopping-
off of the stream of consciousness. One thought that
may be noted can be expressed verbally as follows:
"I wonder if they have sheltered in the shaft-house."
The thought referred to the other members of the party.
It consisted in nothing more than a visual image of
these persons taking shelter in the place in question.
An attempt was made to express the thought in verbal
images, and then in spoken words. In both cases the
product was gibberish. The visual images alone
carried the meaning, and the verbal images that they
would ordinarily have aroused oy association refused
to be invoked. One point is worth noting : When by
dint of persistent effort a few coherent words were at
last mentally or orally produced (this occurred when
the attack was passing off), these words could usually
be mentally or orally repeated. Any considerable
pause annulled the possibility.

Unfortunately it was not noticed whether visual
images of words could be aroused. If any had ap-
peared spontaneously, they would undoubtedly have
been detected.1 No attempt was made to read or

1 The writer can ordinarily arouse faint visual images of printed
or written words. These images do not usually accompany his
verbal thought.

134 THE PSYCHOLOGY OF STAMMERING

write. This matter was entirely overlooked. No
auditory images were present apart from the auditory
images in the mental jargon. This mental jargon —
like the writer's ordinary verbal imagery — was
auditory-motor with practically only the vowel-ele-
ments in auditory terms. Motor images of hand-
and arm-movements were fairly clear. They were,
perhaps, somewhat less definite than under normal
conditions. They appeared to be a little "labored,"
but were still well defined. This impression of
labored kinaesthetic images may have been produced
by the numbed condition of the body.

The abnormal manifestations of speech gradually
disappeared when the writer returned to a more
sheltered part of the mountains where he was pro-
tected from the severity of the wind. All marked
disturbances disappeared within half an hour; but
throughout the day there was a decided tendency
toward syllable-stumbling. Words were frequently
misplaced in the sentence. A severe headache was
experienced for several hours after the incident.

The aphasia was undoubtedly induced by cold.
The tenuity of the atmosphere could not alone have
been responsible for the disturbance, for at other
times greater altitudes — with more favorable weather
conditions — produced no such effect.

The cerebral disturbance was undoubtedly some
functional derangement in the kinaesthetic verbal

APHASIA 135

centre. This diagnosis was borne out by introspection.
When an attempt was made to express a thought in
internal language, there resulted a sort of spasm of
kinaesthetic images. The motor images of articu-
lative movements had passed out of control : they
"exploded" into consciousness instead of rising in
the mind in an orderly manner ; and they were,
moreover, promiscuous and inappropriate. Auditory
images of vowels followed the kinaesthetic images of
consonants, but since the consonants were inap-
propriate, the vowels cannot be said to have been
either right or wrong.

An analysis of the symptoms shows that the defect
could not have been in the auditory centre. An
affection of the auditory centre would not be likely to
induce jargon-aphasia with the writer, for the leading
centre is in his case the kinaesthetic centre. Whatever
auditory images exist are aroused by association with
motor images of initial articulative movements. In
this jargon-aphasia, however, the words began incor-
rectly, the articulative movements themselves being
beyond control.

A comparison of this case with the one preceding
shows again that disturbances in speech and thought
vary according to the prominence of the different types
of imagery in the thought-processes. Dr. Osborn's
patient was not able to speak, because he could not
recall the necessary kinaesthetic images. He was able

136 THE PSYCHOLOGY OF STAMMERING

to think in words because he could recall words in
auditory terms. The writer was unable to speak be-
cause he, too, could not recall the kinaesthetic images ;
but he was unable to think in words because — unlike
the former subject — he could not recall these words
in auditory terms.

AUDITORY APHASIA

We come now to the consideration of speech-dis-
turbances induced by lesion of the auditory verbal
centre, — in the posterior part of the first temporal
convolution (A. V. in Figure 5). Total destruction
of this centre entails obliteration of the auditory
images of words. As a consequence there is, of
course, complete word-deafness, and the patient
understands nothing that is said to him. If the
patient is an audile, there is likewise complete
verbal amnesia, and the patient cannot think in
words. If the person affected should be a marked
articulo-moteur, no verbal amnesia need result, for
the words are still thought in kinaesthetic images.
The patient is then able to read, write, and speak
with normal facility. Word-deafness, however, in-
variably exists.

It must be understood that the word-deaf patient
hears quite clearly what is said to him, for even when
there is extensive damage to the memory-hemi-
sphere of the brain, the impressions are still received

APHASIA 137

by the uninjured hemisphere. The words, however,
convey no meaning. The patient hears merely a
confusion of oral sounds that might as well be words
in a foreign language. If the injury to the auditory
centre is slight, the word-deafness may be incom-
plete, and the patient understands here and there a
word that is spoken to him, or understands a simple
sentence if it is several times repeated. If a severe
lesion is restricted to the auditory verbal centre, the
patient — though completely word-deaf — readily in-
terprets ordinary physical sounds. He understands
the significance of a knock at the door, the ringing
of a bell, the ticking of a clock, etc., and he recognizes
and appreciates music.

As already stated, the severity of the disturbance
in verbal thought and speech is dependent upon the
degree of prominence of the auditory verbal imagery
under normal conditions. The symptoms in different
cases are by no means uniform. There may be
complete verbal amnesia or no amnesia whatever.
The disturbance in speech is, of course, commensurate
with the disturbance in internal language, — for the
patient cannot speak words that he is unable to think.
There may be some amount of paraphasia due to
"uncontrolled" activity of the kinaesthetic memory-
centre. The speech is paraphasic because there is
no auditory imagery to guide it. This symptom is
more likely to prevail in ear-minded persons.

138 THE PSYCHOLOGY OF STAMMERING

The following is a case of auditory aphasia due to
destruction of the auditory verbal memory-centre : 1

"A woman, aged 43 years, who had never suffered from
deafness or affection of vision, was attacked on June 22, 1880,
with right hemiplegia and aphasia. She remained in the hos-
pital until August 4, when she was discharged. At this time
the patient could speak, but she spoke unintelligibly, and was
sometimes believed to be intoxicated. She not only could not
make herself understood, but she could not understand what
was said to her.

" She was received into the hospital again on September 10,
with slight paresis of the left arm. The right hemiplegia had
entirely disappeared. The patient was looked upon as insane.
She was absolutely deaf, so that she could not be communicated
with."

At the autopsy a lesion was found in the auditory
verbal memory-centre. The lesion encroached upon
the second and third temporal convolutions. There
was a somewhat similar lesion in the right hemisphere,
but this would not have affected the verbal memory. —
The patient was able to give utterance to oral sounds
because the kinaesthetic memory persisted. The
speech was defective because there was no auditory
imagery to guide it, and because the patient was de-
pendent upon auditory cues.

In the following case (reported by Pick 2) it will be

1 Bastian, "Aphasia and Other Speech Defects," pp. 161 f.
Quoted by Bastian from Ferrier, "Lectures on Cerebral Localization."

2 Archiv fur Psychologie, 1892, p. 909. Quoted by Bastian,
" Aphasia and Other Speech Defects," p. 166.

APHASIA 139

seen that the patient was an articulo-moteur, and that
there was no verbal amnesia or defective speech despite
the fact that the auditory memory-centre was totally
destroyed :

"A day laborer, aged 24, was completely word-deaf, and
behaved like a deaf person, taking no notice of ordinary sounds
near him. It was found that he only noticed loud calls, clap-
ping, or ringing of bells, and this not always readily. Yet if
one shouted to him unexpectedly, he said, angrily, 'Don't
shout at me so ' ; and he often said spontaneously, ' I hear quite
well, but I don't understand ; I can hear a fly flying past me.'
His power of recognizing airs previously known to him seemed
to be also lost.

"His speech was perfectly correct. He spoke fluently, and
only occasionally hesitated about the right word. He named
objects shown to him correctly. He could not repeat words
or phrases. Writing was executed slowly but quite correctly,
though he could not write from dictation. With regard to his
power of copying, nothing could be stated, as he could not be
persuaded to make the attempt. He read aloud easily and
quite correctly, and he understood both print and writing
perfectly. Writing afforded the only means of communicat-
ing with him apart from gestures. The patient's condition
in the above-mentioned respects remained essentially unchanged
during the whole period of his stay in the hospital, from January
17 to May 12, 1891.

"At the necropsy the upper parts of both temporal lobes
were found to be shrunken, soft, and of a yellow color. On
the left side the posterior half of the upper temporal convolu-
tion and the supra-marginal gyrus were the parts that were
softened. The island of Reil was intact. On the right side
there was softening of the upper temporal convolution and a

140 THE PSYCHOLOGY OF STAMMERING

great part of the second temporal, as well as of the island of Reil,
together with some small foci in the lower part of the ascend-
ing frontal [precentral], and in the third frontal convolution."

Since the auditory verbal memory-centre was de-
stroyed, the only reasonable explanation for the ab-
sence of amnesia and speech-disturbances is that the
man was an articulo-moteur, and that verbal images
subsisted normally in kinaesthetic terms. Like other
people that have no auditory imagery, he would,
before his illness, recognize sounds when he heard
them, but he would be unable to revive them as
acoustic images in his mind. This absence of acoustic
images accounts for the absence of speech-disturbances
and amnesia when the auditory centre was destroyed.
The patient suffered no more in speech than would
a congenitally deaf person that had mastered oral
language.1

1 TBe suggestion has been made that this patient spoke, like an
orally taught deaf person, from visual as well as from kinaesthetic
cues. This is highly improbable. One that has made no study of
visual speech has practically no optical images of the different posi-
tions and movements of his articulative organs. Let the reader
verify this statement by endeavoring to obtain visual images of the
different movements that his speech-organs would execute in pro-
ducing the sentences he is at present reading. If he has not made
a study of visual speech, he will find these images to be rudimentary
to the last degree. He probably cannot tell, without an actual trial,
whether in the enunciation of the letter F, the upper teeth touch
the lower lip, or the lower teeth touch the upper lip. If visual
images of speech exist, they will be confined almost exclusively to
images of labial action. Physiologists have spent years of pains-

APHASIA 141

Instances are not at all rare of patients giving
utterance to familiar phrases after they have suffered
destruction of the auditory memory-centre. The
phenomenon shows what an important part the kin-
aesthetic memory plays in the evocation of speech, —
and, with some people, in the thought-processes.
The following case, somewhat similar to the one
preceding, came under the observation of Hitzig.
The report is taken from Bastian.1

"An old lady, supposed to be suffering from softening of the
brain, was at a loss in speaking for a certain number of words,
whilst she was also very slightly paraphasic. Nevertheless,
she was able to express herself so well that at a first examina-
tion no speech trouble might be noticed.

"She was completely unable to understand what was said
to her. But after a time, when her condition had somewhat

taking work to ascertain the action of the less observable organs of
speech. All this work would have been superfluous if they could
have visualized these actions from the beginning. It can be safely
stated that the average person has visual images of the action of his
speech-organs no more than he has visual images of the movements
of his diaphragm.

If this laborer had visual images of speech-movements, he should
have been a competent lip-reader and should have had no difficulty
in interpreting spoken language.

Visual images of printed or written words need not be considered.
They cannot incite speech : they arouse the speech-images only by
association. The only images that they could arouse in this instance
would be kinaesthetic.

It seems clear, then, that in this case the incitativcs of speech
were kinaesthetic images of articulative movements.

1 Loc. cit., pp. 329 f.

142 THE PSYCHOLOGY OF STAMMERING

improved, Hitzig says, ' She took notice when one pronounced
certain words, though I believe she did not understand them,
but that she recognized rather by analogy the sound of what
was uttered, looking to her previous experiences.'

"She had, however, very completely preserved her com-
prehension of music ; she appreciated airs that were sung or
whistled ; and she herself sang and reproduced airs, though not
always very correctly.

"After a time she showed symptoms which pointed to the
existence of a new focus of softening — this time in the right
hemisphere.

"At the necropsy an area of softening was found in the left
hemisphere, occupying principally the temporal lobe and more
especially the posterior two-thirds of the first temporal convolu-
tion. This old softening was probably the cause of her word-
deafness. In the right hemisphere there was a symmetrical
focus of recent date in the temporal lobe." 1

It will be seen from the nature of the lesions that
the auditory images of words must have been destroyed;
yet the patient gave utterance to complete sentences.
As a rule, intelligent speech is inhibited by a lesion
in the auditory verbal centre, and it is only in rarer
instances that the patient gives expression to several
words in rational sequence.

1 A somewhat similar case is reported by Wernicke in "Der
Aphasische Symptomencomplex." This is quoted by Ballet, "Le
langage intSrieur et 1'aphasie," ad ed., p. 86; and by Wyllie, "Dis-
orders of Speech," p. 285.

APHASIA 143

THE RELATION BETWEEN MOTOR AND AUDITORY
APHASIA

It might be profitable to consider at this juncture
the points of similarity and difference between motor
and auditory aphasia. These points may best be
studied under three headings : the reception and
interpretation of speech; the retention of the
verbal images in memory; and the expression of
oral speech.

The Reception and Interpretation of Speech. — In
auditory aphasia, the word-deafness is always com-
mensurate to the amount of damage in the auditory
verbal centre. When destruction of the centre is
complete, the word-deafness is complete. If only part
of the centre is destroyed, or if the whole centre is
enfeebled rather than annihilated, the patient may
interpret an occasional word that he hears, or may
grasp the meaning of a whole phrase if it is several
times repeated to him. If the patient happened to
be an orally taught deaf person, it is evident that a
lesion in the first temporal convolution would have
no injurious effect upon speech ; the integrity of this
centre would not be necessary, since the patient
would interpret speech entirely by vision.

It seems at first sight that there should be no word-
deafness with pure motor aphasia, since the auditory
word-images are not affected. No word-deafness

144 THE PSYCHOLOGY OF STAMMERING

occurs with the audile, but the articulo-moteur may
have difficulty in interpreting spoken language.
However, he gathers the meaning when the words are
slowly and clearly uttered, or he understands them
when they are repeated. When the auditory centre
is destroyed, the word-deafness is, on the other hand,
complete.

The Retention of the Verbal Images in Memory. —
The amount of amnesia that exists with a lesion in
the auditory or kinaesthetic memory-centre varies
with the prominence of the different types of imagery
in verbal thought. The audile has his internal lan-
guage annihilated if an injury occurs to the auditory
verbal centre. On the other hand, the articulo-
moteur or the orally taught deaf person finds that his
internal speech is practically unaffected by such a
lesion. When an injury occurs to Broca's centre,
it is the articulo-moteur that suffers: his verbal
memory is expunged. The pure audile — Guido
Banti's patient is an example 1 — thinks in words as
freely as ever.

The audito-moteur suffers when either centre is
affected, the degree of the amnesia varying, of course,
with the individual. Wyllie believes that verbal
amnesia is common with motor aphasia. He says :

"There is reason to believe that in every case of severe motor
aphasia that is due to destruction of the motor images, Amnesia

1 See p. 126.

APHASIA 145

Verbalis is extremely well marked, — even more so, perhaps,
than it is in severe cases of auditory aphasia." 1

Collins expresses a similar opinion :

"Patients with cortical motor aphasia often show great
amnesia and lack of comprehensive grasp of facts that have
been communicated to them since their illness." *

The Expression of Oral Speech. — The impairment
of oral speech is proportional to the amount of kinaes-
thetic amnesia that exists. If destruction of Broca's
centre is complete, the patient becomes mute even
though he may think clearly in auditory images of
words. Frequently a few of the brain-cells seem to
escape damage, and the patient gives expression to
such recurring utterances as "tan-tan," "list com-
plete," etc. When the impairment of the kinaesthetic
centre is functional rather than organic, or when the
lesion is slight, the patient may exhibit a considerable
degree of jargon-aphasia or paraphasia. He gives
utterance to meaningless syllables when he attempts
to speak, or uses words that are entirely inappropriate.

When the auditory area is affected, the patient's
ability to speak is proportional to his ability to sum-
mon the kinaesthetic images of words independent of
his images of hearing.8 With Pick's patient we see

1 "Disorders of Speech," p. 312.
*"The Faculty of Speech," p. 173.

1 On this subject Starr writes as follows : " If, in the patient with
word-deafness, there is no accompanying word-blindness, he may

146 THE PSYCHOLOGY OF STAMMERING

that there was full ability to recall these images of
feeling.1 With the audile, no such ability would be
likely to exist, and the patient would be unable to
give utterance to intelligible speech. At best there
would be paraphasia and jargon-aphasia, due to the
uncontrolled activity of the kinaesthetic centre. With
a partial disablement of the auditory centre, para-
phasia is likely to result. The degree of jargon-
aphasia is determined largely by the severity of the
lesion.

When the auditory area is enfeebled rather than
destroyed, the patient can usually repeat words that
he hears spoken. This matter will be discussed sub-
sequently at greater length.

The cases of aphasia cited in the preceding pages
are typical of disturbances that occur with degenera-
tion in strictly delimited cortical areas. It frequently
happens, however, that a lesion covers only part of a

be able to read aloud as well as to himself — that is, his motor speech
memory may be aroused by way of his visual memories without the
intervention of the auditory memories. And if he has no apraxia
[loss of concepts] it is also possible for any of the concept memories
to awaken the motor speech memory; hence the thought of an
object or seeing it may lead to the enunciation of its name without
thought of how the name sounds. For this reason patients who
are word-deaf and cannot understand what is said to them may be
able to talk fairly well." ("Organic and Functional Nervous Dis-
eases," 2d ed., pp. 456-457.)
1 PP- 139 f-

APHASIA 147

particular centre. The function is then only partially
inhibited. In other cases the lesion falls along the
borders of two adjoining centres. It then happens
that there is impairment of both faculties, but sub-
version of neither. In other cases, again, the lesion
may be more extensive and may affect two or three
centres simultaneously. Several subjective disturb-
ances, such as auditory and visual amnesia or word-
deafness and mind-blindness, then coexist, and the
patient's intelligence is reduced to a minimum.

ASSOCIATIONAL APHASIA

Lesions producing aphasia are not necessarily
situated in the cerebral cortex; they are frequently
found in the association-tracts uniting the different
centres of the brain. As already stated (p. 115), a
lesion severing the fibres between the primary visual
centre and the visual verbal memory-centre will
produce word-blindness without agraphia. The pa-
tient cannot read because the visual impressions
do not arouse their associated memory-images.
These memory-images can, however, be aroused spon-
taneously, and they are at the service of the patient
when he desires to write. He writes spontaneously or
from dictation, but he cannot read what he has him-
self written.

It has already been explained that in such cases the
patient sometimes manages to read in a rather crippled

148 THE PSYCHOLOGY OF STAMMERING

way by tracing the letters with a pen or with his
finger. In these cases the kinaesthetic sensations
arouse the visual images of the words, and the process
is exactly the reverse of that which takes place during
the act of writing.

All ideas that are associated by contiguity can thus
arouse one another mutually. The association, as
already stated, is stronger in the direction represent-
ing the order of the occurrence of the impressions ;
but it exists in the other direction none the less.
Pathological phenomena show that the association-
fibres conducting stimuli from one centre to another
are not the same as the fibres conducting stimuli in
the reverse direction ; in other words, the association-
tracts are double. Since contiguous association can
take place between any two ideas, one naturally con-
cludes that there must be double association-tracts
between any two brain-centres that may be designated.

A peculiar condition, known as optic aphasia, is
produced by interruption of the fibres that convey
stimuli from the visual memory-centre to the verbal
memory-centres. There is no object-blindness. The
patient recognizes objects with facility: but the
stimulus cannot pass to the verbal memory-centres;
hence the patient is unable to recall the names of
objects that he sees. When the object is made to
appeal to another sense — touch, hearing, or taste,
for instance — the patient is able to name it immedi-

APHASIA 149

ately. He might, of course, do the same thing if he
suffered from pure object-blindness ; but since there
is no object-blindness present and no amnesia (for
the name can be aroused through other channels), it
follows that the difficulty is merely one of association.

If the lesion happened to occur in the set of fibres
that convey stimuli from the auditory word-centre
to the visual memory-centre, there would result — in
the eye-minded person, at least — a marked degree of
word-deafness. The subject would hear the words,
but the words would not arouse their visual associates ;
hence in many instances they would not be under-
stood. The condition would differ little from word-
deafness produced by degeneration of the auditory
centre. There would, however, be less disturbance
in physical speech.

Theoretically there are as many different associa-
tional disturbances as there are association-tracts in
the cerebrum. Many pathological cases have been
recorded that bear out the different classifications.
But most of these cases show complications due to the
encroachment of the lesions upon other parts of the
cerebrum, and in many instances, too, no autopsical
examination has been recorded; hence it would not
be profitable to consider these cases at length. The
characteristic symptoms of any particular case should
be obvious from what has already been said concern-
ing association and the nature of aphasia.

150 THE PSYCHOLOGY OF STAMMERING

A few remarks, however, may be made concerning
the defects of speech that result from a breach in the
fibres uniting the auditory and kinaesthetic word-
centres. These fibres cross the Sylvian fissure,
passing beneath the island of Reil. Undoubtedly
they are double, but owing to their propinquity they
are not likely to be separately damaged. The nature
of the disturbances attendant upon damage to these
fibres is determined by the relative prominence of
the two centres in the verbal processes. A pure
articulo-moteur would suffer no disturbance in oral
expression. Speech would be initiated from Broca's
centre, and the isolation of this centre from the audi-
tory region would have little significance. The audito-
moteur or audile (the audile, of course, becoming an
audito-moteur where oral expression is concerned)
exhibits jargon-aphasia or paraphasia from a similar
lesion. There is usually no word-deafness, or no more
word-deafness than would result from destruction of the
kinaesthetic centre. Internal language is not impaired
in the pure audile or pure articulo-moteur, though
naturally it becomes affected in the audito-moteur if he
is not able, after the occurrence of the lesion, to restrict
his verbal thought to one particular type of imagery.

The following is a case of paraphasia due to inter-
ruption of the audito-kinaesthetic association-tract : l

1 Collins, "The Faculty of Speech," p. 418. The case was orig-
inally reported by Lichtheim.

APHASIA 151

"A man, forty-six years old, with incomplete right-side
hemiplegia. No history could be obtained. Examination
showed that the patient understood spoken, written, and
printed speech. The most remarkable feature of the case was
paraphasia, which was so great that spoken speech was quite
unintelligible. He was aware of the mistakes in his production
and tried to assist himself by pantomime. Writing was very
imperfect ; he disarranged the order of the letters and the words,
and it was difficult to get him to make efforts of writing. The
same defect was manifested in attempting to repeat as when he
endeavored to speak voluntarily. He retained the ability to
copy. The autopsy showed extensive lesions, the chief one,
according to the writer, being of the island and of the floor of
the Sylvian fissure."

The symptoms vary greatly in different cases;
hence the foregoing case cannot be said to be typical.
The paragraphia indicates impairment of internal
language or the existence of complications affecting
the visual area or fibres connected with it.

When damage occurs to the projection-fibres lead-
ing from the motor areas of the brain, the resultant
disturbance is aphemia. The symptoms are identical
with those produced by a lesion in the motor cortex.
Internal language is, of course, unaffected.

AMUSIA

Amttsia is a generic term for disturbances in the
musical faculty. These defects are quite analogous
to the various forms of aphasia. We find tone-deaf-

152 THE PSYCHOLOGY OF STAMMERING

ness, note-blindness, musical amnesia, etc., analogous
to the different defects in speech. Defects in the
musical and speech faculties may coexist or exist
independently of each other.

The independent occurrence of disturbances in the
musical faculty points to the existence of a separate
centre presiding over the musical memory. The
facts of development carry similar import.

"Musical recognition in childhood often precedes verbal
recognition.1 Musical expression usually precedes verbal ex-
pression, both when there is clearly inherited musical tendency,
and in ordinary imitative reactions." 2

The disparity in the development of the musical
and speech faculties is often remarkable. Ballet
states 3 that Stumpf's child could sing the scale
correctly at the age of fourteen months. He cites
further the case of the son of the composer, Dvorak,
who at one year could sing with his nurse the march
from " Fatinitza." At eighteen months he could sing
his father's songs, the latter accompanying him on the
piano. The faculties of speech and song frequently
interfere with each other's development. The writer
has a nephew that developed a remarkable propen-
sity for singing at the age of two. When less than

1 Verbal recognition of course requires the establishment of asso-
ciations. — C. S. B.

2 Baldwin, "Mental Development of the Child and Race," p.
440.

1 "Le langage intdrieur et 1'aphasie," ad ed., p. 24.

APHASIA 153

two and a half, he could sing accurately the melody
of " La donna e mobile," from " Rigoletto." But when
the musical faculty began to develop, all attempts at
speech seemed to disappear. At the age of three the
child began to employ words again, but he had then
no more command of language than he had at eighteen
months.

This independent development of the faculties
would scarcely take place if the musical and auditory
verbal memories were subserved by the same centre.
Physiologists are pretty well agreed that the auditory
musical memory resides in the anterior portion of the
first temporal convolution. The posterior two-thirds,
it will be remembered, presides over the auditory
memory for spoken words. When the whole superior
temporal convolution is damaged, there result both
amusia and aphasia. When the lesion is limited to
the anterior portion, there occurs amusia without
aphasia. When the damage is restricted to the
posterior portion, aphasia alone results.

The visual memory for musical notations seems to
reside in a different portion of the cortex from that
presiding over the memory for ordinary letters. The
visual images pertaining to music are probably stored
in the general visual centre.

Tone-deafness is usually accompanied by musical
amnesia. Lack of musical imagery is normal with
a large proportion of the race. A certain amount of

154 THE PSYCHOLOGY OF STAMMERING

natural tone-deafness is likewise common, a great
many people being unable to appreciate intricate
classical music. Pathological tone-deafness results,
of course, from actual degeneration in the cerebrum,
and it is often accompanied by word-deafness. Collins 1
cites a case, originally reported by Serieux, in which
there was total word-deafness. In addition, "The
most familiar tunes when played on any instrument
were not recognized. 'Au Claire de la Lune/ was
said to be a 'dead march.' Cafe chantant music
was designated church music, etc."

"Lichtheim has reported a very instructive example of
amusia. His patient was a teacher and journalist, who be-
came completely word-deaf after a second attack of apoplexy.
Communication with the patient could be made only in writing.
He heard when one sang or whistled, but he did not recognize
the melodies. Concert singing by his children was most annoy-
ing because it was 'so noisy.' The most familiar melodies,
such as 'Rufst du mein Vaterland,' were not recognized." 2

Dr. Brazier cites a number of interesting cases of
amusia.3 In one case a tenor in ]the comic opera was
suddenly stricken with musical amnesia during the
performance. He was unable to understand what
was being sung, and was himself unable to produce

1 Collins, "The Faculty of Speech," p. 260.

2 Collins, loc. tit., p. 260.

*"Du trouble des facultei musicales dans 1'aphasie," Revue
philosophique, October, 1892, pp. 337-368. Reviewed in Zeitschrifl
fur Psychologic und Physiologic der Sinnesorgane, Vol. 5, pp. 345 ff.

APHASIA 155

a note. He could speak with fair fluency, but had
forgotten the words and music of his songs entirely.
The disturbance disappeared after several months.
In another case a well-known pianist was playing a
piece from memory, with orchestral accompaniment.
Suddenly he forgot the piece, and the music of the
orchestra appeared to him as a mere confusion of
sounds. There was no trace of aphasia. It is evident
that the disturbances in musical expression were due
in these two cases to the loss of auditory musical
memory.

The musical memory is not necessarily auditory,
though of course it usually takes this form. For
instrumental music, the memory may be visual or
motor. The visile may learn a piece of music by
visualizing the notes, and he would naturally depend
upon his images of sight. The motile can learn to
play pieces from memory, even if he has no acoustic
imagery. Any disturbance in his kinaesthetic imagery
of hand-movements would then interfere with musical
expression. It will be remembered that one of Char-
cot's patients had lost the memory for associated
movements of the hands and mouth necessary for
playing the trombone. In such cases musical ex-
pression would be impaired even if the auditory
memory were unaffected.

Conditions of note-blindness (called also musical
alexia) and musical agraphia occasionally occur.

156 THE PSYCHOLOGY OF STAMMERING

When the damage causing the disturbance is limited
to the visual area, the patient may still play well by
ear. Kussmaul 1 refers to a patient of Finkeln-
burg's that could play well by ear, though he had
lost the power of interpreting written music. A
patient of Lasegue's 1 that suffered from aphasia and
agraphia was able to write the notes to any melody
he heard. A patient of Proust's l could compose and
write music, but was totally unable to play from notes.
This disturbance was probably produced by a lesion
in the fibres uniting the primary and secondary visual
centres. Such a lesion would account for the absence
of musical agraphia, since the visual memory-centre
would be unimpaired.

THE ABILITY OF AN APHASIC PATIENT TO SING

Returning to the subject of vocal music, we find
that the patient is usually unable to sing when he is
unable to speak. However, he may still be able to
hum or whistle airs with the greatest accuracy, or
he may sing by attaching musical sounds to a few
meaningless syllables that he is still able to articulate.
But it occasionally happens that an aphasic patient
can sing words that he cannot express in ordinary
speech. In such cases the defect of speech is un-
doubtedly due to auditory amnesia, the kinaesthetic
word-images being unimpaired. A case of this nature

1 See Kussmaul, "Storungen der Sprache," 4th ed., p. 193.

APHASIA 157

is recorded by a writer in the Psychological Review.1
He says:

"A patient now under his observation [the author writes
in the third person] with total loss of the power of speaking,
the understanding of speech being preserved, is being success-
fully taught to sing in a high pitch words which he cannot be
taught to say."

Bastian quotes a case from Knoblauch, in which
the patient could sing words that she could not
pronounce:*

"The patient was a girl, aged six years, who could neither
read nor write. After recovering from an attack of scarlet
fever followed by nephritis, she was seized with general convul-
sions on December 21, 1886.

'"On December 26 consciousness slowly returned, but there
remained a condition of right hemiplegia with aphasia. The
child could not speak at all at first. Later on she said
" Mamma," and apparently repeated a few words. She could
sing the song "Weisst Du wie viel Sternlein stehen," etc., but
she could not recite the text of the song, or speak voluntarily
single words of the same.'

" Soon after she improved in general health, but on February
8, 1887, she was admitted into the Clinical Hospital at Heidel-
berg on account of the hemiplegia and the speech defects. In
regard to the latter the following details are given: 'Men-
tally, as far as one can judge, she is very well developed. As
she is aphasic she has to make herself understood by gestures ;
spontaneously she only utters "Mamma." She is able to repeat
a few words, but very imperfectly. If one commences the song

1 Vol. i, No. i, January, 1894.

1 Bastian, "Aphasia and Other Speech Defects," p. 288.

158 THE PSYCHOLOGY OF STAMMERING

"Weisst Du wie viel Sternlein stehen," she sings it with the
right melody in an automatic way, being unable either to con-
tinue or to begin afresh when she once stops. All the words of
the text which she is unable to pronounce spontaneously are,
while she sings them, articulated perfectly. The comprehen-
sion of spoken language is quite normal. The patient has not
yet learnt to read or write.'

"After this date she improved remarkably under treatment,
so that by February 21 'she was able to repeat most words cor-
rectly, with considerable trouble it is true. She could count
up to three if some one started her with "one." In the begin-
ning of March she was able to sing the song "Weisst Du wie
viel Sternlein stehen" quite alone, and certainly with a much
purer intonation than at the beginning of the treatment. On
March 8, she succeeded for the first time in reciting the text
of the song without singing the melody. In the beginning of
April the patient had acquired a considerable vocabulary, and
she even attempted to form small sentences. In the middle of
the same month she could utter almost all words, but could not
yet form connected sentences, though she managed to make
herself perfectly understood.'"

Bastian gives an account of another case, which
came under his own observation. The patient was
a woman, aged forty. When admitted to the hospital
(October i, 1897) she was completely word-blind and
almost completely word-deaf. Her condition later
was as follows : l

"November 25. Examination by the House Physician
(Dr. J. S. Collier). No word-deafness now. She corrects me
directly when I make a mistake in the multiplication table.

1 Bastian, loc. cit., pp. 291 f.

APHASIA 159

The only words she uses voluntarily are 'no,' which she uses
correctly, and 'Bull,' the name of the patient next to her. If
the alphabet be repeated slowly to her she joins in and will
continue to repeat it alone correctly. Sometimes, however, she
makes a mistake, shakes her head and says 'no,' and cannot
continue until she is started afresh. When started by counting
aloud, she can count up to twenty alone, with some defects of
articulation, such as 'en' for ten, 'fixteen' for sixteen, 'tenty'
for twenty. She cannot say the easier part of the multiplica-
tion table. She cannot repeat a single word after me. She
was made to say 'eighteen, nineteen, twenty,' about a dozen
times by leading up with 'sixteen, seventeen,' repeated by me
aloud, and then when I asked her to say ' twenty ' she did so at
once, but could not repeat the performance.

"She can sing a tune to order. She commences humming
and then joins in with the words, many of them perfectly articu-
lated, some of them badly articulated, and in the place of others
mere lalling. The following is a specimen of her singing of the
hymn 'Hark, hark, my soul,' her mistakes being printed in
italics.
' Hark, hark, my soul, angelic songs are swelling

O'er earth's green eas (seas) and ocean's nave mint ore (wave-
beat shore),

How sweet the truth those blessed strains are selling (telling)

Of that new life where sin shall be no more.'

"She sang three verses of this hymn. She also sang to order
verses of the following hymns : — ' Onward, Christian soldiers' ;
'Jesu, meek and gentle'; 'Awake, my soul'; 'At even ere
the sun was set' ; and others, as well as some popular ballads,
such as 'Belle Mahone' ; 'Cherry ripe,' etc.

"She can start singing these herself. She can, moreover,
repeat the above mentioned verses without singing if she is
started by my beginning them aloud, but she cannot say them

160 THE PSYCHOLOGY OF STAMMERING

without being first put upon the track. Her articulation of
quite difficult words in the singing is often very good, but in
repeating poetry her articulation is not so good as when she
sings.

" She cannot repeat a single word dictated to her.

"She is still absolutely word-blind. She names letters but
quite wrongly. When shown a letter upside down, she at once
placed it right side up. When shown her own name she evidently
did not recognize it ; she spelt it out, but did not get a single
letter right, thus —

Sarah Brown

iptea eavrno

"December n. She is still completely word-blind; she
cannot pick out a single letter, or recognize her own name spelt
with capitals. She has said a few more words spontaneously,
such as 'oranges' and 'fish.' She still cannot name any object
that is shown to her. She can now repeat words a little, such
as 'father,' 'paper,' 'nice,' — has done so about a dozen times
in all. She understands complicated orders at once, and obeys
correctly."

It will be seen from the foregoing report that the
patient was practically devoid of spontaneous speech,
though she was able to sing with considerable facility.
The fact that she could count, and recite words in
a quasi-automatic manner, is not surprising. This
phenomenon is often seen when the defect occurs in
the auditory centre. The words are produced me-
chanically, and they do not represent verbal thought
in the true sense of the word. When the answer to
a question requires the enunciation of a simple num-
ber, the patient frequently remains mute, — even

APHASIA 161

though he may be able to count in a mechanical way.
Singing may be easier for these patients because it
is a mechanical rather than a thought process.

TRANSITORY APHASIA

Aphasic attacks are often transitory, lasting for
minutes, hours, days, or even months. These attacks
are due to functional disabilities rather than to lesion
of the cerebral tissue.

Daly records a case x in which there were recurring
attacks of transitory aphasia with right hemiplegia.
In one day there were as many as ten attacks, varying
in length from ten to sixty minutes. The patient
would suddenly say, "I am all right again," and the
attack would be at an end. The power in the hemi-
plegic limbs returned almost as soon as the faculty of
speech. Bastian suggests that the attacks were due
to spasms of the cerebral blood-vessels induced by
uraemic poisons in the blood.

Ballet2 states that he has frequently induced
temporary attacks of aphasia in himself by excessive
tobacco-smoking. He ascribes the affection to a
disturbance of the kinaesthetic memory. He has
found his auditory and visual verbal images to be clear
at such times, though the words themselves could not
be pronounced.

1 Quoted by Bastian, loc. cit., pp. 116 f.

*"Le langage inteiieur et 1'aphasie," ad ed., pp. 118 f.

162 THE PSYCHOLOGY OF STAMMERING

Trousseau records the case 1 of Professor Rostan,
who experienced an attack of temporary aphasia.
He was confined to his bed for several days by an
injured leg, and fatigued his brain by excessive reading.
When the attack came on, he noticed that he did not
clearly understand what he was reading. When he
tried to call for assistance, he found that he could not
utter a word. He was also unable to express his
thoughts in writing. He was bled, and he then
found that he could say a few words. The recovery
was gradual, and at the end of twelve hours was com-
plete.

In another case 2 a minister found himself aphasic
one morning, after being exposed on the previous
evening to the night air and receiving "a check to
the cutaneous perspiration." The patient understood
everything that was said to him, but was himself
unable to utter a word. When he attempted to ex-
press himself in writing, he wrote the meaningless
phrase, "Didoes doe the doe." He was bled of fifty
ounces of blood; thereupon he recovered rapidly.

Kussmaul 3 records the case of a thirteen-year-old
girl that remained aphasic for thirteen months, —
the effect of being run over by a vehicle. She re-

1 Cited by Bastian, loc. tit., p. 115.

2 Bateman, "On Aphasia," ad ed., p. 83; quoted by Bastian,
loc. cit., pp. 115 f.

8 "Storungen der Sprache," 4th ed., p. 213.

APHASIA 163

ceived no severe injuries, but remained speechless
from the shock. After various specifics had proved
ineffectual she was treated with potassium bromide.
One day, after taking the medicine, she threw herself
in her mother's arms, and whispered, "Mother, I
am going to speak again." In a few weeks she had
completely recovered her lost faculty.

Intense emotional excitement sometimes induces
temporary attacks of aphasia. Anger or fear may
leave a person speechless for days. Todd l refers
to the case of a man of irritable temperament who
became so excited during a conversation that he
completely lost his power of speech. He remained
aphasic for a week.

The power to "speak with tongues," which ac-
companies religious ecstasy and is frequently re-
garded as a supernatural manifestation, is doubtless
nothing more than a passing attack of jargon-aphasia.

LOWERED EXCITABILITY OF BRAIN-CENTRES

Aphasia frequently results from functional weak-
ness of the verbal centres. In such cases it usually
takes the form of amnesia without word-deafness or
word-blindness. (Defects of this nature are likewise
common when there is incipient softening in the cere-
brum.) The patient forgets first the names of things

1 "Clinical Lectures on Diseases of the Brain," p. 278; cited by
Bastian, loc. tit., p. 124.

164 THE PSYCHOLOGY OF STAMMERING

that he can think of in visual terms ; hence the names
of concrete objects are the first to go. Abstract
nouns, verbs, prepositions, etc., usually have the
verbal image as the nucleus of the concept; hence
the verbal image is in this case less readily displaced.
Amnesic defects are often induced by causes that
affect the cerebrum only indirectly; they operate by
lowering the general vitality of the nervous system.
Such causes are old age, extreme fatigue, debilitating
diseases, etc.

Trousseau has recorded in his Lectures a case of
amnesia due to lowered vitality of the verbal centres: *

"'You remember the experiment that I often repeated at
Marcou's bedside. I placed his nightcap on the bed and asked
him what it was. But after looking at it with close attention
he could not tell what it was called. He would exclaim, "And
yet I know well enough what it is, but I cannot recollect."
When I told him that it was a nightcap, he would reply, "Oh,
yes! it is a nightcap."'"1

The same thing occurred when he was tested with
other objects. He could seldom name them, but he
recognized the names when they were mentioned.
In two minutes the name was again completely for-
gotten. In this case the sole disability was amnesia.
The patient recognized words and could repeat them ;
but owing to the enfeeblement of the verbal centres
he could not arouse the word-images spontaneously.

1 Ballet, "Le langage interieur et 1'aphasie," ad ed., pp. 80 f.

APHASIA 165

Wyllie quotes a similar case in his "Disorders of
Speech." x

The patient, a man aged twenty-seven, sustained
a fracture at the base of the skull. There was some
disturbance in vision, and a slight "motor paresis" in
the right side of the body. At first there was word-
deafness, but this soon passed off.

"The peculiar feature of the case has yet to be stated. It
was a most remarkable shortness of memory for objects seen,
and for words seen or heard. The sound-image of a word, or
the visual image of either a word or an object, could easily be
revived from without, and its revival called up the correspond-
ing idea or meaning in the normal way ; but, as to visual images,
immediately when the object or word was withdrawn from the
patient's sight its image vanished, and he totally forgot what
object or word he had been looking at ; and so also as to sound-
images, he heard the word spoken to him and understood it,
but immediately forgot it, and could not repeat it, even if only
a very short interval was allowed to elapse before he was asked
to do so.

"Shown a knife, he knew what it was, and, if he could not
recall the noun ' knife,' he said it was something for cutting with ;
but if the knife was then placed among other objects, and covered
from his sight for a moment, he could not, when the collection
of objects was again uncovered, tell which of them had been
shown to him.

"It was the same with visual images of letters and words.
Shown, for example, the letter G cut out in wood, he easily
recognized it; but if it was then covered from his sight, and

^'Disorders of Speech," pp. 384 f. The case is recorded by
Professor Grashey, Archiv fur Psych., zvi, 1885, p. 645.

166 THE PSYCHOLOGY OF STAMMERING

placed among other wooden letters, he immediately forgot
what letter he had seen, and failed to pick it out from among
the others, unless he kept repeating to himself 'G, G, G,' and
thus artifically retained it in his memory.

"And it was, again, the same with the sound-images of
words. He could repeat or echo any word spoken to him, but
the memory of it immediately vanished, if he did not retain it
artifically by repeating it over and over again."

In this case, again, it is evident that there was no
destruction of the brain-cells. The defects were due
merely to lowered excitability of the centres.

THE ABILITY OF AN APHASIC PATIENT TO REPEAT

When the disturbances producing aphasia are
situated in the auditory verbal centre, and when the
cortical cells are not destroyed, the patient can usually
repeat words that are spoken in his hearing. He may
possess this ability even when he can utter scarcely a
word spontaneously. The ability of the patient to
repeat words can be regarded as an indication of the
integrity of the kinaesthetic memory-centre.

Instances are numerous in which aphasic patients
have been able to pronounce words spoken in their
hearing. It will be remembered that the little girl that
could sing when she could not speak spontaneously,
"was able to repeat most words correctly" (p. 158).
Even when she sang "Weisst Du wie viel Sternlein
stehen," she had at first to be accompanied, or some
one had to commence the melody for her.

APHASIA 167

The explanation for a patient's ability to repeat
when unable to speak spontaneously is most probably
that the cortical cells are too much enfeebled to permit
the spontaneous evocation of the auditory image, but
not sufficiently weakened to resist the auditory impres-
sion. The sensory stimulus overcomes the inertia of
the cells, and while the primary memory endures, the
patient is able to repeat the words that he could not
otherwise pronounce. The phenomenon sometimes
takes the form of echolalia, and the patient reechoes
almost any word that he hears, frequently attaching
no meaning to it.

This condition was observed in one of Collins'
patients that suffered from word-deafness, word-
blindness, and object-blindness. Part of the report
of the case is subjoined:1

"Examination of this patient eight months later reveals
practically the same condition as above stated, save that the
word-deafness is, if changed at all, more complete. The hemi-
anopsia is very difficult to demonstrate, and, if it exists, it is
very slight. The only change of any import is a marked echo-
lalia that he has developed. If one says, 'How old are you?'
he repeats over and over, 'You, you,' with a rising inflection
on the last letter. 'How is papa?' 'Papa, papa,' repeated and
repeated. Usually he takes the last word of the sentence that
he hears and echoes it, occasionally the last two words. Such
as, ' Will you have an orange ? ' ' An orange, an orange,' he re-
peats — the 'an' with great vigor and clearness of enunciation

1 Collins, "The Faculty of Speech," pp. 257-258.

1 68 THE PSYCHOLOGY OF STAMMERING

and with a rising inflection on the last syllable of orange. Com-
plex words he occasionally attempts to echo, but he does not
succeed in so doing. There is still a degree of that condition
known as mind-blindness, but it is not so conspicuous as when
he was first seen."

Referring to echolalia, Bastian says:1

"A defect of this kind (occurring in a woman who was hemi-
plegic from cerebral haemorrhage) has been recorded by Profes-
sor Behier.1 She was born in Italy, and had resided both in
Spain and France ; of the three languages she had thus acquired
she had completely forgotten the Italian and Spanish, and had
only retained a most limited use of French. In this latter
language she only repeated like an echo the words pronounced in
her presence, without, however, attaching any meaning to
them. But in the case of a woman seen at the Salpe'triere by
Bateman the mimetic tendency was much stronger. She even
reproduced foreign words with which she has never been famil-
iar."

Many cases are recorded in which patients reiterate
words without understanding them. Their failure to
understand words that they are themselves able to
enunciate is due to the involvement of other areas
besides the auditory centre. If the visual memory-
centre were destroyed in an eye-minded person, the vis-
ual associates of the word-images would be abolished,
and the words would be practically destitute of mean-
ing. Many words would retain their meaning by

1 "Aphasia and Other Speech Defects," p. 152.
1 Gazette des Hdpitavx, May 16, 1867.

APHASIA 169

virtue of associated images of touch, hearing, etc. ; but
those that are usually associated with visual images
would fall meaningless upon the ears of the person
affected. Thus there may ensue a degree of word-
deafness from impairment of the visual memory-
centre.

This last condition, impairment of the visual
memory-centre (often with associated defects in the
auditory centre), is probably the defect that exists in
those few cases in which the patient is able to repeat
words spoken by another person and understand
them when he has himself pronounced them. The
auditory impressions are of themselves unable to
arouse the visual images in the partially damaged
centre; but when the auditory impressions are re-
inforced by the kinsesthetic sensations, the conjoint
stimuli are able to overcome the inertia of the damaged
cells. Another possible explanation is that the fibres
conveying stimuli from the auditory to the visual
centre are damaged, and that the stimuli reach the
visual centre indirectly through the kinaesthetic word-
centre. This explanation is open to the following
criticism: The kinaesthetic verbal images must be
present before the words can be orally produced. If
these images can be aroused by the sound of the words,
there seems no reason why they should not excite the
visual images directly, without first expressing them-
selves in oral speech. This criticism is not easily

170 THE PSYCHOLOGY OF STAMMERING

answered. The facts seem to be that the torpid
cells are excited only by the summation of stimuli
from two different sources. This principle of the
summation of stimuli is thoroughly established in
psychology ; and it is one that should be particularly
noted at this point, since we shall revert to it in suc-
ceeding chapters. Where a single stimulus is unable
to produce a given response — a movement, the
arousal of a mental image, etc. — the response is often
produced by the cumulative effect of several different
stimuli. As already suggested, this probably happens
when the word-deaf person is able to understand
words after he has repeated them, — the word-
deafness being occasioned by torpidity of the general
visual centre as well as of the auditory verbal centre.

THE ABILITY OF AN APHASIC PATIENT TO READ ALOUD

The principle of the summation of stimuli is ex-
emplified in many aphasic (or amnesic) patients that
are able to assist themselves by visual stimuli. The
verbal centres may be too weak to permit the sponta-
neous recall of words, but they nevertheless respond
when there is an additional stimulus from the visual
centre. Thus it is sometimes found that a patient
can read aloud, though he cannot express himself
spontaneously. In some such cases it is probable that
the kinaesthetic verbal centre is excited directly from
the visual verbal centre without the intervention of

APHASIA 171

the auditory centre. The images of articulatory

movements are then aroused directly by association.

Graves1 records an interesting case in which an

amnesic patient assisted himself by visual stimuli:

"The man was a farmer, aged 50 years, who had suffered
from a paralytic attack from which he had not recovered at the
time of observation. The attack was succeeded by a painful
hesitation of speech. His memory was good for all parts of
speech except noun-substantives and proper names ; the latter
he could not at all retain. This defect was accompanied by
the following singular peculiarity: he perfectly recollected the
initial letters of every substantive or proper name for which
he had occasion in conversation, though he could not recall to
memory the word itself.

"Experience had taught him the utility of having written
on manuscript a list of the things he was in the habit of calling
for or speaking about, including the proper names of his chil-
dren, servants, and acquaintances; all these he arranged
alphabetically in a little pocket dictionary, which he used as
follows : if he wished to ask anything about a cow, before he
commenced the sentence he turned to the letter C, and looked
out the word 'cow,' and kept his finger and eye fixed upon the
word until he had finished the sentence. He could pronounce
the word 'cow' in its proper place so long as he had his eye
fixed upon the written letters ; but the moment he shut his
book it passed out of his memory and could not be recalled,
although he recollected its initial, and could refer to it when
necessary. He could not even recollect his own name unless
he looked out for it, nor the name of any person of his acquaint-

1 Dublin Quarterly Journal, 1851. Case quoted by Bastian,
"Aphasia and Other Speech Defects," p. 148.

172 THE PSYCHOLOGY OF STAMMERING

ance ; but he was never at a loss for the initial of the word he
wished to employ. "

In a somewhat similar case recorded by Aber-
crombie1 the patient resorted to visual impressions
to assist himself in interpreting spoken language:

" His mental faculties were so entire that he was engaged in
most extensive agricultural concerns, and he managed them with
perfect correctness by means of a remarkable contrivance. He
kept before him in the room where he transacted business a
list of the words which were most apt to occur in his intercourse
with his workmen. When one of them wished to communi-
cate with him on any subject he first heard what the workman
had to say, but without understanding him further than to
catch the words. He then turned to the words in his written
list, and whenever they met his eye he understood them per-
fectly."

This is a case in which there must have been sum-
mation of stimuli — even if we suppose the patient to
have been a typical visile. He would find at best
only one or two words in his written list, but these
would add their weight to the auditory impressions
and assist in overcoming the inertia of those cells
whose torpidity isolated the acoustic sensations.

Lichtheim records a case2 in which the patient was
able to read fluently, although he was aphasic for
spontaneous speech. The patient could repeat quite

1 "Inquiry into the Intellectual Powers," ?th ed., p. 158. Cited
by Bastian, loc. tit., p. 158.

2 Brain, 1885. Quoted by Bastian, loc. cil., p. 150.

APHASIA 173

accurately, so it is plain that the cause of the speech-
disturbance was merely a diminished excitability
of the auditory centre. The patient was a medical
practitioner that had become aphasic as the result of
a carriage accident. There was paresis in the right
arm and leg.

" Speech was much affected ; the first day the patient said
only 'Yes' or 'No,' but quite appositely. Gradually more and
more words returned, at first imperfectly. Whilst his vocabu-
lary was still very meagre, it was observed that he could repeat
everything perfectly. Soon after the accident he began to read
with perfect understanding. It was established beyond doubt
that he could read aloud perfectly at a time when he could
scarcely speak at all. The statements of his wife are most
positive and trustworthy upon this point, though he himself
does not recollect what took place just after the accident. She
states that after much difficulty in making himself understood
by gestures he obtained a newspaper, and to the great astonish-
ment of all present he began to read fluently. She herself
thought it most strange and inexplicable. ... He could not
write voluntarily at all ; but this faculty returned slowly and
imperfectly, as did speech. On the other hand, he could, soon
after he left his bed, copy and write from dictation."

Bastian reports two similar cases in "The Brain

as an Organ of Mind." l Both patients were

aphasic for spontaneous speech. Neither could

repeat very readily ; yet both could read with facility,

— one, indeed, evincing no trace whatever of his

speech-defect when reading. In these cases it seems

1 pp. 623-626.

174 THE PSYCHOLOGY OF STAMMERING

probable that the kinaesthetic centre was excited
directly from the visual verbal centre. The patients
were probably articulo-moteurs in whom the motor
memory-centre had become functionally weakened.
The affection could scarcely have been one of the
auditory centre, for under such circumstances the
patients should have had less difficulty in repeating
spoken language. It is possible, too, that the peculiar
symptoms may have been due to an interruption in
the audito-kinaesthetic association-tract.1 So long as
the visuo-kinsesthetic tract remained uninjured, the
patients might be able to speak when assisted by visual
associations even though they were unable to speak
spontaneously.

INTERJECTIONAL SPEECH

Under strong emotional excitement aphasic patients
often give expression to words or phrases of an inter-
jectional nature.2 This sometimes occurs even when
the patient is otherwise completely mute. Ballet3
cites the case of a distinguished lady whose sole
vocabulary consisted in the expression Sacre nom de

1 In naming association-tracts, the centre is given first from
which the stimulus is supposed to emanate. Thus, activity flows
from the auditory to the kinaesthetic centre through the audito-
kinasthetic tract. It flows in the reverse direction through the
kinasthetic-audUory tract.

2 See p. 1 24.

* "Le langage inteiieur et 1'aphasie," 2d ed., pp. 119-120.

APHASIA 175

Dieu! He states also that the speech of the poet
Baudelaire was limited to the expletive Cre noml ere
noml Numerous cases of like nature are on record.

The explanation for this exclamatory speech may be
found in the greater intensity of the emotional stimu-
lus. Just as several normal stimuli acting concur-
rently may produce a response in torpid cells, so a
single stimulus may produce a response if its intensity
equals that of the sum of the several stimuli.

It has been suggested that familiar and emotional
expressions ("degraded" speech) are represented in
the right hemisphere of the brain. The assumption is
rather gratuitous ; and the fact that it disposes of a
few difficulties is not sufficient warrant for its accept-
ance. It seems more reasonable to suppose that the
different mental images are represented in the cor-
tex by a plurality of cells, and that some of the cells
escape damage. If a few of these undamaged cells
were strongly excited, the effect would be the same as
though a greater number of cells were excited to a less
degree.

It is manifest that a mental image becomes more
deeply ingrained through the repetition of a sensation.
Even when there are extensive organic lesions in the
cerebral centres, the memory of more familiar experi-
ences frequently endures. An aphasic patient may be
practically mute, and yet be able to give expression to
such familiar words as yes and no. Often an agraphic

176 THE PSYCHOLOGY OF STAMMERING

patient can write his own signature, and often a word-
blind patient can read his own name. Frequently the
amnesic polyglot patient loses his memory for one or
more languages, while the memory for his mother-
tongue remains unimpaired. One cannot for a mo-
ment suppose that the destructive processes of disease
respect the conscious content of a cell, — that the
cell presiding over no is less liable to destruction
than the cell presiding over the word negative. But,
since the more familiar expression is less readily
forgotten, the only alternative is to suppose that it is
more extensively represented in the cortex. If this is
the case, there can be no doubt that repetition brings
new cells into activity.

When a lesion is inflicted upon one of the centres in
the memory-hemisphere of the brain, the function of
the centre is in some instances vicariously assumed by
the corresponding centre of the uninjured hemisphere.
This is most likely to occur in early childhood, but
with persistent education it appears to occur in some
instances in later life. The transference of function is,
of course, effected by reeducating the patient. The
word-concepts are not bodily transferred to the un-
injured hemisphere of the brain; they have to be
organized afresh through the reestablishment of
associations. If the auditory centre in the left hemi-
sphere happens to be injured, the cells in the right

APHASIA 177

hemisphere must become active before the auditory
memory can be reestablished. But, for the auditory
images to possess associations of meaning, it is evident
that these new auditory cells must be in physiological
connection with memory-cells in other centres of the
brain. These centres are probably not transferred
from the old hemisphere. They are connected with the
new hemisphere by transverse fibres ; hence the organic
association may be transverse. It is quite clear that
the new associations can be established only by asso-
ciations in actual experience, — and this, too, even
when the memory-cells of the undamaged centres are
not replaced by new ones. Thus the patient has
practically to be educated anew. The process of re-
education is a slow and laborious one. Except in the
case of the very young child, the transference of func-
tion hardly ever takes place spontaneously.

The question may suggest itself as to whether it
would not be desirable for one to strengthen the weaker
image-types lest the more dependable images should
at some time become impaired. It is doubtful, how-
ever, whether the mental images can be developed to
any great extent. Some psychologists have asserted
that the weaker images can be developed by more
frequent use and by the multiplication of associations,
but the matter is really open to question. The subject
will be discussed later in another connection. But,

178 THE PSYCHOLOGY OF STAMMERING

assuming for the time that mental images can be de-
veloped, it is certain that the limit of development
would be low for a type of imagery that does not
freely and spontaneously assert itself. On the con-
trary, the limit of development would be high for the
type of imagery that predominates in one's thinking.
Nevertheless, a limited development of the rudimen-
tary imagery might be considered more desirable than
no development at all. The trouble, however, is this :
One does not possess the ability and intelligence to
direct one's thinking during that period of life when
the mind is in the plastic state. By the time the
necessary ability and intelligence are acquired, the
mental characteristics are practically established ; and
though it may be possible to strengthen the weaker
imagery to a limited extent, the salient mental traits
will be unalterable.

Whatever may be the degree to which mental
images can be developed, it is certain that it would be
of little benefit for one to strengthen the weaker im-
ages merely as a safeguarding measure in case of depri-
vation of the more dependable faculties. Cerebral
lesions are of rare occurrence, and a person suffering
such injuries is usually unequivocally hors de combat.
When the lesion is not fatal to life or intellect, there
occurs spontaneous development of those faculties
that remain unimpaired, and they then reach a degree
of efficiency that would formerly have been unattain-

APHASIA 179

able. Considering the other side of the question:
should some misadventure result in the obliteration of
a carefully strengthened type of imagery, then the
ensuing loss would be far more disastrous than would
have been the case if the imagery had remained unde-
veloped. However, cerebral lesions are too infrequent
to warrant the adoption of psychological prophylactic
measures ; and any development of imagery that may
be possible will be resorted to for utilitarian purposes
and not as a safeguarding measure against an unlikely
contretemps.

CAUSES OF APHASIA

The causes of aphasia are somewhat arbitrarily
differentiated as functional and organic. In reality
there is no such division, for functional defects are
in themselves due to organic causes; though the
abnormal organic conditions may not be visible to the
naked eye. Strictly speaking, even chemical changes
are organic. The classification of defects as functional
and organic is one only of convenience.

Among the most obvious of the organic causes of
aphasia is laceration of the cerebral tissue. This is
usually due to penetration of the skull by some foreign
body. A splinter of bone may itself press upon the
brain or may lacerate the cortex. This sometimes
happens when the cranium is struck by a dull body, —
as the result of a fall, for instance. Sometimes aphasia
occurs from these causes when there is no fracture of

i8o THE PSYCHOLOGY OF STAMMERING

the skull. In such cases there is laceration of the finer
cerebral fibres, or the disturbance is induced indirectly
by the mental shock.1 Further organic causes are
cerebral tumors or abscesses, inflammation of the brain,
softening of the brain (often due to obstruction of the
cerebral blood-vessels), rupture of the cerebral vessels,
tuberculosis of the meninges, etc.

Among the so-called functional causes of aphasia
are temporary obstruction of the cerebral vessels,
spasm of the vessels, etc. Cerebral congestion may
likewise induce aphasia. Aphasia is often due to
nervous exhaustion following overwork, mental fa-
tigue, worry, etc. Another frequent cause is a toxic
condition of the blood — due to lead or copper poi-
soning, poisoning by stramonium, belladonna, etc.
A toxic condition may likewise be caused by snake-
bites, acute alcoholism, bromide intoxication, excessive
tobacco-smoking, and — when the poison is engendered
within the system — by diabetes, gout, Bright's disease,
typhoid fever, smallpox, measles, etc. In general, it
may be said that aphasia can be induced by any
cause that brings about an abnormal condition in the
cerebrum.

1 See p. 226.

CHAPTER VII

STAMMERING

WE come now to the consideration of stammering.1
Our first task will be to ascertain the cause of this
speech-defect. For convenience, we shall consider
first the theory of its cause that finds at the present
time the widest acceptance among pathologists.
This theory supposes that stammering is due to a de-
•lay in vocalization ; in other words, to the stammerer's
inability to produce voice.2 The theory was first
promulgated by Dr. Neil Arnott, in 1827, in his

1 The word stammering is used in this work generically unless an
antithesis between stuttering and stammering is expressed.

It will be seen later that the distinction between stammering and
stuttering is an artificial one. Stuttering is usually defined as a form
of defective speech manifesting itself in repetition of the initial
consonant. Stammering is defined as a form of a defective utterance
characterized by strangulatory and compressive effort — or as any
minor form of speech-hesitation that is not stuttering. Much con-
fusion has arisen in these definitions through English and American
authors translating the German word stammeln (lolling or baby talk
in its milder forms) as stammering.

1 The pathologist regards this phenomenon more as the form in
which stammering manifests itself. The "inability to vocalize" is
represented as the cause rather by ignorant quacks, who guard this
as one of the secrets of their profession.

181

182 THE PSYCHOLOGY OF STAMMERING

"Elements of Physics." Later the theory was sup-
ported by Merkel in Germany.1 Merkel no doubt
advanced the theory independently, as many other
writers have done since the time of Arnott.
Wyllie expresses the theory as follows : 2

"In the common variety of stammering the speaker neg-
lects the laryngeal mechanism ; and, when no speech is emitted,
he unwittingly throws increased force into the wrong quarter,
viz., the oral mechanism, whose nerve centres thus become
surcharged with energy, which may overflow into other centres
and produce spasmodic complications. . . .

"That the defect of speech in the common variety of stam-
mering is due to Delayed Action of the laryngeal or vocal
mechanism in attacking the first syllables of words, is an old
proposition ; and is also to the present day maintained by the
best writers on the subject."

Bastian holds the same view concerning the cause of
stammering : 3

" Stammering is a hesitating, spasmodic speech defect often
beginning about the fourth or fifth year, and much more com-
mon in boys than girls, which is due not so much to a want of
precision or coordination in the action of the several groups of
muscular elements constituting the oral articulatory mechan-
ism, but rather to a want of accord between the action of the
laryngeal and the oral speech mechanisms. There is mostly a
lagging action of the former."

1 "Schmidts Enzyklopadie der ges. Medezin," Bd. VI, 1844.

2 "Disorders of Speech," pp. 2-3.

• "Aphasia and Other Speech Defects," p. 58.

STAMMERING 183

It is easy enough to show that the difficulty of the
stammerer is in some way connected with the pro-
duction of the vowel, and that the consonant is not
the obstacle, as would appear to the casual observer.
The arguments in support of this proposition are as
follows :

a. When the stammerer falters on a continuous
consonant, he usually prolongs the consonant for
several seconds. He stammers on the word six, let
us say, and produces the s continuously. Now, the
fact that he is producing the 5 shows clearly that he
has no difficulty in articulating the consonant. His
difficulty is to produce the vowel ; and as soon as the
vowel is uttered, the sibilation stops. In a mono-
syllabic word that has no final consonant — the word
so, for example — the word is complete as soon as the
vowel is enunciated. The same arguments apply in
every case of continuous stammering. The diffi-
culty is not with the consonant, since this is usually
produced to excess. The consonant is prolonged only
because the vowel is delayed.

b. In stuttering, the consonant is produced repeat-
edly. The speaker attempts to say ten; but he pro-
duces a series of *'s and the word becomes t-t-t-ten.
Since the t is repeatedly articulated, the difficulty
cannot lie with the consonant. The t is repeated only
because the succeeding vowel refuses to appear.
(Unlike the letter s, the t cannot be produced con-

184 THE PSYCHOLOGY OF STAMMERING

tinuously; hence it is repeated when the vowel is
delayed.) The same argument applies in every case
of stuttering upon explosive consonants. The con-
sonant is repeated; hence there is no obstruction to
its articulation. The repetition is occasioned only by
the delay in the appearance of the vowel.

c. If the stammerer's difficulty lay with the articula-
tion of the consonant, he would stammer quite as much
at the end of a word as he does at the beginning. The
stammerer, however, never hesitates at the end of a
word:

"No stammerer has ever faltered in attaching the consonant
to the vowel in such syllables as ad, ek, ik, ob, for the reason
that it is quite impossible for him to do so." 1

d. That the difficulty does not lie with the conso-
nant, but with the vowel, is borne out by the fact that
stoppage often occurs when the word begins with a
vowel. The stammerer may find the word any as
difficult as many, and angle as difficult as dangle.
When he stammers on the initial vowel, there can be
no question concerning difficulty with consonants.
Often there is no consonant at all in the word, and the
difficulty appears with such words as 7 and a.

e. The stammerer rarely has difficulty in singing.
But song differs from speech chiefly in the manner in
which the vowels are produced ; while there is mani-

1Merkel, " Anthropophonik," p. 908. (Quoted by Denhardt,
"Das Stottern eine Psychose," p. 28.)

STAMMERING 185

festly no radical change in the consonants. The
absence of the stammerer's impediment in song
indicates, then, that the vowels occasion the difficulty
in speech.

From these arguments it is evident that the stam-
merer's trouble is due to the delay of the vowel.
Hence the theory arises that the stammerer is unable
to produce voice, — that his difficulty is due to a lag-
ging of the laryngeal action.

Unfortunately this theory does not take account of
all the facts, and the facts that it disregards are
sufficient to refute it. If the stammerer's impedi-
ment were due solely to his inability to produce voice,
then all trace of the impediment should vanish as
soon as he begins to whisper, for in whispering no
phonation occurs. But actual experience shows that
the impediment persists in approximately two cases
out of three (Hermann Gutzmann).1 This is con-
clusive evidence that the difficulty does not lie with
the production of voice, as such.

A second fact shows just as conclusively that the
difficulty is not one of vocalization. One often stam-
mers on continuous sonant consonants, and in this case
there is continuous production of voice. In endeavor-
ing to pronounce the word many, the stammerer may
produce the m as a continuous humming sound. Here

1 Kussmaul, "Storungen der Sprache," 4th ed., p. 352.

186 THE PSYCHOLOGY OF STAMMERING

there is certainly no delay in the action of the
larynx.

Still another fact bears witness that the stammerer's
difficulty is not one of phonation. The stammerer
often vocalizes when stammering or stuttering upon a
vowel. One writer says, when speaking of repetitive
utterance : l

"It is by no means uncommon for a stammerer to go through
the same process of repetition when trying to pronounce a
word commencing with a vowel."

Kreutzer, in endeavoring to defend the thesis that
stammering is a "refusal of the voice," writes as fol-
lows : 2

"If the answer is made that frequently a stutterer repeats
a vowel, as E-E-E-E-E in Emil, A-A-A-A-A in Adolf, etc., and
that therefore I cannot say that the 'E' and the 'A' are the
obstacles, I must still maintain my ground, for a closer examin-
ation soon reveals that all the stutterer vocalizes is only a part
of the 'E' and the 'A,' and that the vowels are never perfectly
formed."

These facts clearly show that the stammerer's
difficulty is not one of phonation. But they show
further that his difficulty is in some way connected
with the production of the vowel. When the stam-

1 Mrs. Emil Behnke, "On Stammering, Cleft-Palate Speech, Lisp-
ing," p. 10.

J "Kreutzer's Method" (The Voice, 1881, Vol. Ill, p. 175).

STAMMERING 187

merer hesitates while whispering, he produces the
initial consonant repeatedly or continuously, and is
unable to pass to the vowel, — or he may hesitate on
a vowel if it begins a word. When, in speaking aloud,
the stammerer falters on a continuous sonant conso-
nant, he produces the consonant as continuous voice,
but is unable to pass to the vowel. When he vocalizes,
but does not complete, an initial vowel, the difficulty
is in some way connected with the vowel itself.

Now, since the stammerer's difficulty is to produce
the vowel, and is not to produce voice per se, it is
evident that his difficulty must be to produce the
vowel-color or vowel-quality. The stammerer's difficulty
is transient auditory amnesia: he is unable to recall
the sound-image of the vowel that he wishes to enun-
ciate. This, then, is the thesis of the present mono-
graph.

The stammerer is an audito-moteur. He relies for
his speech-cues upon both kinaesthetic and auditory
images. When he stammers in enunciating a word, it
is because there is complete failure of the auditory
image. His futile struggles with the initial consonant
are directed solely by his kinaesthetic imagery, but
he cannot pass to the vowel because he cannot recall
its sound, its peculiar or characteristic quality, — in
short, the vowel-color. When he attempts to speak
the word ten, he produces the / entirely by feeling ; but
he cannot mentally hear the sound £, and is hence

188 THE PSYCHOLOGY OF STAMMERING

unable to proceed. His mental imagery might be
diagrammed as follows — T-N ; with the capitals
representing kinaesthetic images of articulatory move-
ments, and the hyphen representing a mental hiatus.
It would be more accurate to represent the mental
image as T-, simply; the consonant representing a
kinaesthetic image, and the hyphen representing an
auditory blank. The kinaesthetic image of the N does
not appear during the stammerer's futile efforts to
articulate. The diagram T-N represents, however,
the verbal image as it occasionally appears in silent
thought.

The assumption is not made in regard to the stam-
merer's normal verbal imagery, that he has an auditory
image only of the color of the vowel. Many stam-
merers may have an auditory image of the entire
word, but so long as the image fails to appear during
speech, stammering must inevitably result. The
stammerer's kinaesthetic image of the initial articula-
tory movements would permit him to struggle with
the word, but till the auditory image arose in his
mind he could not complete it. It is, however,
primarily the failure of the auditory vowel-image that
occasions the stammerer's difficulty, for the auditory
impression of the consonant is generally supplied by
the actual stammering.

The theory that stammering is occasioned by the
speaker's inability to recall the auditory image of the

STAMMERING 189

vowel-color l is borne out by practically every mani-
festation of the defect and every phenomenon con-
nected with it.

In the simplest form of stammering there occurs
merely a pause between the consonant and the vowel ;
the pause, of course, being occasioned by the speaker's
inability to redintegrate the necessary auditory image.
Kussmaul says of this form of stammering : 2

"There are slighter forms of the impediment in which the
defect manifests itself only in undue prolongation of the con-
sonants g, k, iv, etc. In our younger days we were more amused
than was seemly at the speech of an old nurse, who spoke some-
what as follows : ' K-h-ommen Sie endlich ? Der K-h-affee
ist schon etw-h-as k-h-alt.'"

The defect, it will be seen, is not a prolongation of
the initial consonant, but simply a delay in the appear-
ance of the vowel. The defect differs from ordinary
stuttering or stammering only in the fact that the
initial consonant is not repeated (stuttering) when the
vowel-image fails to appear, and that there is no at-
tempt to force the utterance of the word by undue
pressure upon the consonant (stammering).3

In severe cases of stammering it quite frequently

1 It will be seen later that auditory amnesia is not the primary
cause of stammering when the disturbance has been induced by
imitation.

1 "Stdrungen der Sprache," 4th ed., pp. 246-247.

1 In stammering, the articulative effort is, of course, occasioned
by the inordinate expression of the kinaesthetic image. The stam-

ipo THE PSYCHOLOGY OF STAMMERING

happens that the speaker, after fearful struggle with
a word, gives utterance to an entirely inappro-
priate vowel. This fact shows that the conditions
affecting the vowel-image are abnormal. Through
defective internal audition the wrong auditory vowel-
image is invoked, or no auditory image is invoked and
the vowel is produced kinsesthetically. Kussmaul has
remarked this mutilation of sounds in syllable-stum-
bling and "stammeln" — forms of speech-defects that
sometimes coexist with stammering:1

"With the syllable-s tumbler as well as the 'stammler,'
one sees quite frequently an interchange of related sounds;
u and iy u and e, oe and e, u and o, hard and soft consonants,
etc. Or the preceding or succeeding consonant leads to the
use of the wrong vowel in the middle of the word because the
correct vowel involved a too difficult transition." 2

Hunt also refers to the occurrence of this phe-
nomenon in cases of stammering : 8

"Let us take a simple case: when the stutterer cannot pro-
duce a vowel sound, — a vowel stutterer. In this case two ac-
tions are requisite; first, the air must be expelled from the

merer finds himself checked at the consonant when the auditory
image fails to appear. He struggles with the consonant largely
through ignorance of the conditions.

1 Kussmaul considers the cause of stammering to be " a congenital
irritability or weakness of the syllable coordinating apparatus"
(loc. cit., p. 247).

2 Kussmaul, loc. cit., pp. 220-221.

1 "Stammering and Stuttering," yth ed., p. 239.

STAMMERING 191

lungs ; next, the vocal cords in the larynx must be in a posi-
tion to vibrate. The difficulty in this case is caused by the
inability to associate the action of the muscles of expiration with
that of the vocal cords. ... To take a more complicated case :
The stutterer can produce the sound, but cannot articulate it
so as to form the desired vowel. Here the lungs act normally,
but the disharmony lies in the coordination of the action of the
vocal with the articulating apparatus. For instance, take the
word how. His lungs being supposed to act normally, he sounds
the aspirate h and a part of the vowel. Here we must observe
that the sound ow in the above word is a compound sound —
au and oo.1 He produces the sound au, but fails in conjoining
it with the succeeding sound oo. This requires the retrac-
tion of the tongue and the protrusion of the lips. The same
difficulty of coordination is visible here. A stutterer of this
kind, unless his respiration is at fault, in which case no sound
can be produced, finds no difficulty in producing the pure
vowel sound, neither has he any difficulty in the movements
of the lips and tongue when not speaking ; but when these are
required to be associated for the formation of speech-sounds,
he hesitates and stutters."

On another page the same writer says, after re-
ferring to another form of stammering : 2

"In others, again, the vowel can be formed in the larynx,
but the stutterer is unable to complete its formation, or conjoin
it with a consonant, by the intervention of the articulating
organs. This is especially the case with the sounds *', a (ay),
ow, etc."

1 The elements of the diphthong ow can be more accurately rep-
resented as ak-oo (as in far and who), or in Bell's Visible Speech
symbols as J» or ft. — C. S. B.

1 Hunt, loc. cit., p. 246.

192 THE PSYCHOLOGY OF STAMMERING

Ssikorski likewise describes the distortion of the
vowel, — and, like Hunt, has a physiological explana-
tion for it : l

" For example, the vowel u somtimes sounds more like o —
this because the lips were not rounded and protruded to the posi-
tion for u when the spasm 2 appeared, but were merely moving to-
ward this position. The same phenomenon may be observed
in the production of other sounds as well."

Beesel, Colombat, and other writers also describe
this imperfect production of the vowel.

When an inappropriate vowel replaces the correct
one, there is either a wrong auditory image in the mind,
or there is no auditory image and the vowel is pro-
duced kinaesthetically. When a diphthongal vowel is
only partially produced, there is either failure of part of
the auditory vowel-image, or — what is more likely —
there is failure of the whole image, and part of the
vowel is motorially initiated. As a rule, the part of
the vowel that is produced is entirely incorrect.

Another striking phenomenon shows conclusively
that the stammerer's difficulty lies with the auditory
vowel-image. Often stammering occurs only when
particular vowels appear in the word. The nature of
the initial consonant then has little effect upon speech.
This fact has been noted by Denhardt : 8

1 Ssikorski, "Ueber das Stottern" (from the Russian), p. 75.

1 These spasms will be discussed later (pp. 263 ff.).

• Rudolph Denhardt, "Das Stottern eine Psychose," p. 31.

STAMMERING 193

" Sometimes one meets stammerers for whom particular con-
sonants are difficult only when they occur in conjunction with
particular vowels. Thus, ko, ku, and tu may be difficult ; but
not ka and ta"

Stekel reports a case of this kind : l

"The third case that I had occasion to handle concerns a
gentleman that was unable to pronounce words containing the
vowel a. Words in which the a occurred twice were especially
difficult. It cost him a great deal of effort to pronounce such
a word as cataract, and it was extremely painful for him to em-
ploy such words in conversation. At a social affair he once
mispronounced the word papa as popo."

It will be noticed that in this case there was diffi-
culty with particular vowels, and sometimes mutila-
tion of the vowels when they were finally pronounced.

As a rule, particular vowels are difficult only be-
cause their auditory images are more difficult to recall.
The most difficult vowels for the stammerer to re-
dintegrate are those that are least definite and tangible
in their coloration. For this reason stammering
occurs with far greater frequency on the short vowels
than it does on the long vowels.2 The stammerer is
less likely to have trouble with the word light than
with the word lit. This is because the long vowel i is
clearer and more tangible than the short vowel i.

1 "NervSse Augstzustande und ihre Behandlung," p. 233

1 Pitman gives the long vowels as ah, d, e, aw, d, 65 (pa, may, we,

all, go, loo), and the short vowels as d, t, I, 6, u, 66 (thai, pen, is, not,

much, good).

194 THE PSYCHOLOGY OF STAMMERING

The auditory image of the former vowel is more read-
ily redintegrated. It is, as it were, more definite and
substantial, and the mind can better recall it. An
analogy may be drawn between vowel-color and color
as it actually appeals to vision. The long vowel in
light might be compared to a vivid and definite green,
and the short vowel in lit to an intangible and indefi-
nite gray. The vowel in bate might be characterized
as red, and the vowel in bat as indefinitely brown.
The long vowels are found to have more definite color
as they fall upon the ear, and the distinction is even
more marked as they are recalled in auditory imagery.
The long vowel may be mentally heard with con-
siderable clearness when the short vowel absolutely
refuses to rise in consciousness. When this vowel-
sound fails to appear, the stammerer can no more
pronounce it than the musician can tune an instru-
ment from a key-note that he has not heard.

As already stated, the short vowels fail more fre-
quently than the long vowels ; hence they afford the
stammerer greater difficulty. This fact has been rec-
ognized by a number of writers. Dr. Findley says : 1

"Syllables with a short vowel are much more difficult to
utter than those with a long or broad sound ; thus it is much
easier to say bate, beat, bite, danger, than to say bat, bet, bit, death.
In the case of uttering the different consonants, there is no
uniformity, some being more difficult to one, others to another,

1 The Voice, April, 1885 (article, "Stammering").

STAMMERING 195

generally the mutes give more trouble than the semivocals.
In this respect the experience of the same person is not
uniform."

Itard, who wrote nearly a hundred years ago, says
of the matter : l

"A good deal also depends on the vowel with which the
consonant is combined ; thus stammerers find less difficulty in
articulating co than ca,"

In 1830, Hervez de ChSgoin wrote as follows:2

"It is possible to convert the difficult word baliveau into a
very easy one without changing the consonants b, I, and v, but
by changing the vowels that follow b and v. To illustrate, b&
replaces ba, li remains unchanged, and vier takes the place of
veau. The word thus becomes btlivier, a word that would cause
me no difficulty, though I hesitate on the word baliveau."

9

It will be noticed that in this case the short and
intangible vowels have given place to others of a more
definite coloration.

Wyneken says hi regard to long and short vowels : 3

"I may remark that according to my own experience these
consonants are especially difficult when combined with a short
vowel or diphthong (au, ai, eu). Most stammerers find the
words Bann, Pappel, and Kamm more difficult than Bahn,
Papel, and Kam. And even at the beginning of a word the short
vowels and diphthongs occasion stammering more frequently

sur le be'gaiement" (Journ. universel des sciences
medicates, 1817).

1 " Recherches sur les causes et le traitement du be'gaiement," p. 8.
1 "Ueber das Stottern und dessen Heilung," p. 6.

196 THE PSYCHOLOGY OF STAMMERING

than the long vowels. Thus the words Otto and Ammen are
more difficult than the words Otho and Amen." 1

Statements similar to those quoted above are made
by most writers on the subject of stammering.

It is interesting to note that the stammerer, when
employing synonyms for difficult words, usually re-
places a short vowel by a long one. It often happens
that the initial consonant is retained; so it is quite
evident that the consonant itself presents no difficulty.
Thus the stammerer says saneness instead of sanity ;
gamester instead of gambler; dine instead of take din-
ner; etc. In these cases there is a change from a short
to a long vowel, though the initial consonant remains
unaltered. The change is made from the short vowel
to the long one because the long vowel has a more
distinct coloration, and hence can be more readily
recalled.

There is another striking phenomenon that shows
clearly the relation between stammering and auditory
amnesia. The stammerer can almost invariably
articulate a word as soon as some one pronounces it
for him. The explanation is, of course, that the
acoustic impression supplies the refractory auditory

1 The writer can scarcely agree with Wyneken that diphthongs
occasion stammering more frequently than the long vowels — though
they frequently occasion a more conspicuous form of stammering
for the reason that the speaker can commence them but cannot finish.
Many of the long vowels are themselves diphthongs, but the short
vowels are invariably monophthongal.

STAMMERING 197

image from without, and that the stammerer need not
then struggle to arouse the image in his mind. After
he has heard the word that he was trying to enunciate,
he is able to pronounce it while the primary acoustic
image remains clear. As soon as this primary memory
fades, he stammers on the word as before.

The ability of the stammerer to repeat has been
noted by practically every writer on the subject of
stammering. Kussmaul says : l

"The impediment ceases as soon as some one pronounces
the refractory word by way of assistance."

Dr. Rafael Coen makes the following observation : 2

"I spoke the word after the stutterer, and immediately he
could say it without the least hesitation. This is a fact that I
have observed in all stutterers [stammerers] and which enables
me to distinguish stuttering [stammering] from kindred speech-
affections."

And thus Denhardt : 8

"As a rule, the stammerer can repeat without hesitation a
word that he hears pronounced. One observes this very fre-
quently when he pronounces the word for the stammerer in
order to put an end to his painful struggles. One pronounces
the difficult word himself, expecting the stammerer then to pro-
ceed. But before continuing his conversation the stammerer
almost invariably articulates the refractory word, — and this
too without the slightest difficulty; although only a moment

1 "StSrungen der Sprache," 4th ed., p. 244.

* The Voice, Vol. VII, p. 22 (article, "Stuttering").

» "Das Stottern eine Psychose," p. 51.

198 THE PSYCHOLOGY OF STAMMERING

before, the word seemed checked by insuperable obstacles.
As a rule, the spasm is suspended the very moment the stam-
merer hears the recalcitrant word from the lips of his compan-
ion, and it gives place at once to the appropriate and thoroughly
normal conformation of the speech-organs."

This ability of the stammerer to repeat is attributed
by Denhardt to the reassurance the speaker derives
from the knowledge that he is already understood.
Kussmaul offers a similar explanation. Undoubtedly
the reassurance mitigates the stammerer's difficulty ;
but this is not the chief reason for his fluency, for he fre-
quently stammers when he knows that he is understood,
and he stammers sometimes when he is alone. The real
explanation is that the auditory impression furnishes
the mental image that was not previously forth-
coming. When the auditory impression is supplied,
the stammerer speaks with fluency whether his words
are anticipated or not. The following remark by
Wyneken bears out this statement, and the reader will
agree that it is replete with significance : 1

"I knew a schoolboy that was unable to recite his lesson
unless a companion near-by first pronounced the words quietly
for him."

It is self-evident that the difficulty in a case of this
kind must be auditory amnesia.

It will be remembered that in the preceding chapter
(pp. 166 ff. and 172-173) several instances were cited
1 "Ueber das Stottern und dessen Heilung," p. 19.

STAMMERING 199

in which patients suffering from auditory amnesia were
able to repeat words without the slightest difficulty even
when their speech-disturbances were so severe that they
could utter very few words spontaneously. Stam-
mering is a form of auditory amnesia ; thus it is not
surprising that it should exhibit this same phenomenon.
Ball records a case 1 that shows clearly the effect of
auditory amnesia. The patient developed the dis-
turbance after exposure to cold. There was complete
aphasia for several weeks, but gradually the patient
began to reacquire command of language. "He had
partial word-deafness from the commencement ; and
later on he said, 'The words I can't pronounce are
the words I can't hear.'" At the necropsy a lesion
was found covering the inferior parietal lobule and
the posterior part of the first temporal convolution.
It is evident from the location of the lesion that the
auditory word-centre was affected. The patient was
unable to understand particular words because the
auditory cells subserving them were impaired. But
on account of this impairment he could not invoke
the auditory images, and hence was unable to pro-
nounce the words in question. This phenomenon
precisely illustrates the amnesic condition that oc-
casions stammering ; though in stammering, the
amnesia is transitory and word-deafness is little in

'Quoted by Bastian, "Aphasia and Other Speech Defects," pp.
3*7 i.

200 THE PSYCHOLOGY OF STAMMERING

evidence. The stammerer's difficulty is less severe
because the cerebral disturbance is usually functional
rather than organic.

The ability of the stammerer to repeat words that
are pronounced for him finds its parallel in his ability
to repeat a word that he finally succeeds in uttering
for himself. When the auditory image is at last
redintegrated, the stammerer pronounces the desired
word, the sound of the word comes back through the
ear, and the auditory image is strengthened. The
result is that the stammerer can repeat the word in-
definitely, so long as he does not allow the auditory
image to fade into its former obscurity. The im-
munity with the particular word is only transient, and
when the primary auditory image has disappeared,
the stammerer finds the word as difficult as ever.1

The stammerer can usually read or speak aloud in
unison with other people. This is another fact that
has been noted by most writers on the subject of

1 A peculiar fact should be noted at this point. When the stam-
merer has not been understood and is requested to repeat a word,
he cannot always do so. The reason for this is twofold. In the first
place, the auditory impression from the word is not definite and
clear. If the word had been clearly pronounced, it would have been
understood by the person listening. If the word is not clearly
enunciated, it is evident that the auditory image cannot be greatly
strengthened by the aural sensation. The second reason for the
stammerer's inability to repeat is that he is seized with mental con-
fusion and fear. The effect of these last two factors will be better
understood after the perusal of succeeding chapters.

STAMMERING 201

stammering. Hunt quotes one of his correspondents
to the following effect : l

"In private and alone I can read and speak without stutter-
ing at all ; and not only so, but in church can join in all of the
responses of the congregation without hesitation, my voice be-
ing borne along as it were by theirs ; for if their voices suddenly
were silenced, I should become perfectly speechless."

The explanation for the stammerer's fluency under
such conditions is that he is supplied with the auditory
impressions of the words by those around him —
the case being somewhat analogous to the stammerer's
repeating words spoken by another person.2 He de-
rives the same assistance from the auditory impres-
sions that the musically amnesic patient derives from
an accompaniment.

Wallaschek3 cites the case of the opera singer,
Emil Scaria, who was suffering from some incipient
cerebral disturbance. The patient was affected by
amusia, and found himself unable to recall the notes
he had to sing. He therefore requested the manager
that some one be allowed to accompany him upon the
stage and sing the notes quietly with him, as he could
not otherwise remember the music. There seems to

^'Stammering and Stuttering," 7th ed., p. 272.

1 Undoubtedly the stammerer is also assisted by the fact that
general auditory impressions tend to facilitate the arousal of the
sound-images. (See pp. 347 ff.)

1 " Die Bedeutung der Aphasie f tlr die Musik-vorstellung " (Zeit-
sckriflfUr Psychologie, Vol. VI, p. 9).

202 THE PSYCHOLOGY OF STAMMERING

have been no aphasia; the patient's difficulty lay
apparently only with the pitch. Musical amnesia of
this kind is quite common even when no cerebral
defects are present. It is recognized as the lack of
a "musical ear." Often the person cannot keep in
tune when he sings by himself, but has no difficulty
if some one sings with him or whistles or plays the
melody for him. The person with musical amnesia
cannot recall the appropriate pitch, but he proceeds
without difficulty as soon as the pitch is supplied by
the auditory impressions from without. With the
stammerer it is not the pitch, but the vowel-color, that
is difficult of recall ; and as soon as this is supplied,
the stammerer speaks with perfect fluency.

Another fact showing the relation between stam-
mering and auditory aphasia, and showing the effect
of tangibility of the auditory image, is that the stam-
merer can almost invariably sing without difficulty.
In the preceding chapter (pp. 156-160) several in-
stances were cited in which aphasic patients could
sing quite readily, although they had practically no
command of voluntary speech. Thus it is not sur-
prising that the stammerer should sing without evinc-
ing the impediment.

The stammerer's ability to sing could be most
easily explained on the supposition that disparate
brain-centres preside over the auditory memories
for speech and music. It is practically certain that

STAMMERING 203

the anterior part of the first temporal convolution
presides over the musical memory, but it is not en-
tirely certain that this centre presides over vocal
music. It is possible that it may store up the memory
merely of instrumental music or the memory for
pitch ; hence it is desirable to find an alternative ex-
planation that does not premise the existence of dis-
crete auditory centres for speech and vocal music.

The ability of the stammerer (and sometimes of the
aphasic patient) to sing is readily explained by the
greater tangibility of the auditory image in singing.
As the long vowel is more tangible than the short
vowel, so the musical tone is more tangible than either.
The auditory impressions derived from singing the
words " It was the New Jersualem " to their accustomed
melody are infinitely more definite and substantial
than the auditory impressions derived from speaking
the words in a conversational tone at conversational
speed. The words, when sung, are more likely to re-
main in memory in auditory terms. The kinaesthetic
images, it should be noted, are practically identical
in speech and song. It is the auditory images alone
that differ. In song, the auditory nucleus is more
substantial.

The musical memory must subsist largely in auditory
terms, for it is almost exclusively a memory of pitch.
When a note is sung, it maintains the same absolute
pitch through its entire duration, and this pitch is

204 THE PSYCHOLOGY OF STAMMERING

retained in memory. In speech there is inflection,
and the pitch changes even during the enunciation of
a single syllable. The pitch, then, is the principal
element in song, and vowel-color is purely secondary.
As a rule, the vowel-color is sacrificed by the singer,
and the auditor is quite unable to tell what words are
being sung. This surrender of vowel-color is another
reason for the stammerer's ability to sing, for his
difficulty lies with the vowel-color and not with the
pitch. Even if the vowel-color were accurately
rendered in singing, one could readily explain its
greater intensity in auditory memory by the fact that
the vowel has a greater duration. In speech, the
stammerer has less difficulty with the so-called short
vowels that have a relatively long duration 1 than he
has with those that are actually accorded a staccato
utterance.

It should be noted that the stammerer cannot sing
songs of every kind without difficulty. A "patter"
song, by reason of its rapid movement, often causes
as much difficulty as speech. The notes are of short
duration, and the singing approximates ordinary
speech. It is only when the notes are actually

1 The short vowels as well as the long vowels can, of course, be
prolonged till the breath is exhausted. The designation short and
long is rather inapt. The difference is one of color rather than of
length, for even in speech the "short" vowels often possess a rela-
tively long duration.

STAMMERING 205

lengthened, and vowel-color gives precedence to pitch,
that the stammerer's difficulty in singing vanishes.

To summarize these arguments : The stammerer's
ability to sing is accounted for by the greater sub-
jective tangibility of the general auditory impression,
and the consequent greater tangibility of the auditory
image. Fluency in singing is further explained by
the fact that, in song, pitch is preeminent, while vowel-
colors are subordinated.

These facts present the psychological reasons for
the stammerer's ability to sing. They do not neces-
sarily presuppose that singing is a special faculty
subserved by a special brain-centre. But whatever
may be the facts in regard to special localization, and
whatever the subjective facts concerned, the mere
ability of the stammerer to sing supplies a potent
argument in support of the thesis that stammering
is a form of auditory aphasia.

It is possible to adduce a physiological reason for
the fact that the stammerer sings more readily than
he speaks. The inflection of speech demands a far
more complicated action of the vocal organs. During
the rise and fall of pitch there is an increase or de-
crease in the tension of the vocal cords, — this change
of tension requiring delicate muscular action. In sing-
ing, each single note remains at a definite pitch, and
there is no change in the tension of the vocal cords till
the next note is reached. This is the explanation that

206 THE PSYCHOLOGY OF STAMMERING

is generally advanced for the stammerer's freedom
from his defect in singing. There is, however, no
occasion to look for physiological explanations, for
the various paradoxes of stammering are certainly
of psychological origin.1

Sufficient has been said of the subjective aspect of
stammering to show that it is caused by a failure
of the auditory image to rise in consciousness, -
in other words, that it is due to auditory amnesia.
Subsequently, further evidence will be adduced in
support of this thesis; but we shall now consider
more directly the points of objective similarity be-
tween stammering and aphasia.

It is generally conceded by investigators that stam-
mering is a form of aphasia, but the defect is usually

1 There may sometimes exist a physiological disturbance in the
brain, but there is no physical defect in the peripheral organs.
The absence of physical defect in the organs of speech is easily
demonstrated. The stammerer usually enjoys fluent speech for
several years before the inception of the impediment; hence his
speech-organs cannot be malformed. Furthermore, there are almost
invariably certain circumstances under which the stammerer can
speak with facility after the development of the impediment. He
speaks without stammering in the presence of friends, or perhaps in
the presence of strangers; almost invariably he speaks well when
alone. He repeats with facility, and speaks well in concert with
other people. He does not always stammer on the same words ; and
he can repeat — after he has once pronounced it — almost any word
that occasions difficulty. Whenever there exists a defect in the
peripheral organs, the disturbance in speech manifests itself im-
partially under all conditions.

STAMMERING 207

classified as subcortical motor aphasia, or aphemia.
Stammering has rarely been studied as an aphasic
disturbance. Indeed, the objective study of stam-
mering has in general led to negative results. The
symptoms are variable, and there is usually an absence
of cerebral lesion; thus the pathologist finds few
clews whereon to base his classification. A few cases
of stammering have been recorded in which cerebral
lesions were present,1 but these lesions have usually
been sufficiently extensive to be lacking in significance.
Furthermore, in such cases the stammering is a col-
lateral disturbance, the major defect being really a form
of aphemia. The patient stammers in his attempt to
speak, but he stammers on all words impartially ; he
uses inappropriate consonants as well as vowels, and
his speech is more or less an incomprehensible jargon.
These cases cannot be considered as forms of true stam-
mering, and no valid deductions can be made from
them.

Stammering resembles aphasia in its mode of origin.
Broadly, it may be stated that any cause that induces
aphasia can also induce stammering. Most of the
causes that occasion stammering can also produce
aphasia. (The two causes of stammering that do not
produce aphasia are association and imitation.
Stammering arising from these causes is not of the

'See Kussmaul, "StQrungen der Sprache," 4th ed., p. 161 and
pp. 318 ff.

208 THE PSYCHOLOGY OF STAMMERING

amnesic form ; it will be considered in a later part of
the chapter.) The causes of stammering, as given
by Ssikorski,1 are — emotional shock, traumata, in-
fectious diseases, cachexia, convulsions (and imita-
tion). These same causes, it will be seen, are among
the most prolific causes of aphasia.

Transitory stammering frequently occurs, and its
causes are similar to those inducing transitory aphasia.
Some of these causes cited by Kussmaul2 are —
mental strain from overwork, lack of sleep, the smok-
ing of too strong tobacco, intoxication, epileptic fits,
indigestion, acute infectious diseases, etc. Temporary
aphasia or stammering often occurs during febrile
illnesses, disappearing as soon as the fever subsides.
Stammering often occurs as the result of anaemia
following severe illnesses. When the anaemia is acute,
after loss of blood from injuries, for instance, com-
plete aphasia often results.

Stammering sometimes begins as aphasia.

"H. Schmidt records a case in which a hussar was kicked
by a horse on the left side of the forehead, and suffered as a
consequence from aphasia, deafness in the left ear, and paralysis
of the right arm. Gradually the aphasia disappeared and
stammering took its place. After four weeks his full vocabu-
lary returned, but the stammering persisted." 3

1 "Ueber das Stottern," pp. 232 ff.

2 "Storungen der Sprache," 4th ed., p. 247.

1 H. Gutzmann, " Sprachheilkunde," 2d ed., p. 381.

STAMMERING 209

Many such cases are on record in which stammering
has begun as aphasia.

Stammering, like aphasia, often begins with a period
of complete mutism, and is often preceded by a period
of unconsciousness. Ssikorski l observed twenty-
seven cases of stammering due to emotional shock,
and six of these were introduced by mutism. The
duration of the mutism varied from a few hours to
six months. Four of these twenty-seven cases began
with loss of consciousness.

Stammering sometimes takes the form of temporary
mutism, and the defect is not necessarily stammering
speech. (See p. 344; also H. Gutzmann, "Sprach-
heilkunde," 2d ed., p. 419.)

"There are stammerers that never stumble in speech, but
that stammer, nevertheless. This sounds paradoxical, but is
none the less a fact." *

Stammering varies in severity with the tone of
the nervous system ; the same thing is often true of
aphasia. Finally, it may be said that there are all
degrees of stammering, which range from a slight hes-
itancy in speech to an impairment of utterance that

1 "Ueber das Stottern," p. 232.

1 H. Gutzmann, "Sprachheilkunde," 2d ed., p. 408. Gutzmann
believes these subjects to be breath-stammerers. It seems more
probable that the subjects simply experience amnesia, and suppress
the physical contortions of the average stammerer. See p. 312 for
explanation of common breath-stammering.

210 THE PSYCHOLOGY OF STAMMERING

ninquestionally is aphasia. Speaking of severe forms
of stammering, Liebmann says : l

"The worst cases are those in which the speech-disturbance
approximates a form of dumbness. I have seen stammerers
that were unable to utter a word for weeks, and this, too, in sur-
roundings so favorable as the stammerer's own home."

Speech-disturbances of such severity can scarcely
be regarded as stammering : they are aphasia.

One of the strange features of stammering is that it
occurs with far greater frequency in the male than in
the female sex. There are four or five male stam-
merers to every female stammerer. The chief reason
for this disproportion is probably the greater varia-
bility of the male sex; the explanation is thus pri-
marily biological. In most respects the male shows
a greater variability from the norm. Color-blindness
occurs in approximately one man in every twenty,
but in only one woman in two hundred. The male
sex supplies both the geniuses and the idiots of
the race. Mentally, females vary little, and any
extreme variation from the norm is seldom witnessed.
Deaf-mutism is more common among males and so
also is aphasia. In reply to an inquiry from the
writer, Dr. Wyllie says :

"My impression is that aphasia is decidedly more common
in the male than in the female sex."

1 "Stottern und Stammeln," p. 46.

STAMMERING 211

Dr. Joseph Collins reports similarly :

"Aphasia when not due to trauma tism is much more com-
mon in the males than in the females, the report being that the
underlying pathological condition, namely, the various forms of
cerebral softening,1 are much more common in males than in
females."

When cases of aphasia due to traumata are included,
the proportion of aphasia among males is still greater,
for they are more exposed to physical injury.

Dr. Bastian's monograph, "Aphasia and Other
Speech Defects," contains reports of one hundred and
fourteen cases of aphasia. Of these cases, seventy-
one occur in males and forty-three in females. The
cases are, of course, selected to illustrate different
principles and not to demonstrate the proportion in
which aphasia occurs in the sexes. These numbers
may or may not represent the true ratio that exists,
but they certainly indicate that aphasia is commoner
among males.

Thus stammering and aphasia resemble each other
in the fact that they both occur more frequently in
the male sex ; and one of the chief reasons for this we
may consider to be the male's greater variability.
There is perhaps another reason why females stammer
less frequently, and this is that their auditory imagery

1 "It is known that males are more subject to brain tumor than
females." — M. Allen Starr, "Organic and Functional Nervous Dis-
eases," 2d ed., p. 574.

212 THE PSYCHOLOGY OF STAMMERING

is probably more intense. Gallon has shown by sta-
tistical inquiries that visual imagery is stronger in
women than in men. The auditory images are prob-
ably clearer also. Certainly girls talk at an earlier
age than boys; and conversableness is, in general,
greater in the female sex. These facts indicate a more
intense verbal imagery. If the auditory imagery is
more intense, a minor functional derangement would
be less likely to obliterate or obscure it ; and hence
would be less likely to induce stammering. This
fact itself would be sufficient to account for the less
frequent occurrence of stammering among women.

Another point of resemblance between stammering
and aphasia is furnished by the stammerer's occasional
ability to read with fluency. This ability of the
stammerer has been noted by most writers on the
subject. Liebmann remarks that : 1

"Some stammerers read much more fluently than they
speak."

Another writer says : 2

"There are many confirmed stammerers and stutterers who
read aloud without impediment."

The similar ability of some aphasic patients to read
with fluency has already been observed (pp. 170-174),
and the probable cause for it explained.

1 "Vorlesungen iiber Sprachstorungen," i. Heft, p. n.

1 George Vandenhoff, Homeopathic Times, New York, May, 1877.

STAMMERING 213

The interjectional speech of the stammerer is often
free from impediment.

"It is well known that when stammerers are roused by in-
dignation, a sense of wrong, etc., they are frequently released
from their infirmity, or at least the latter is considerably dimin-
ished." »

It will be remembered that a similar fluency of
speech under the influence of emotional excitement
is often evinced by aphasic patients (pp. 174-175 and
p. 124) ; hence we have another point of resemblance
between stammering and aphasia.

We shall consider now a case of aphasia that bears
in many points a remarkable resemblance to stam-
mering. The speech-disturbance was more severe
than that occurring in ordinary stammering, being
apparently due to an organic lesion. There was
mute-aphasia for several months; but when speech
returned, many of the characteristic features of
stammering were present. The case is recorded by
Bastian : 2

"W. D., aged 20, was seen by me in September, 1885, in
consultation with Dr. W. A. Phillips.

"He left England in good health in October, 1884, for a tem-
porary residence in Calcutta. After his arrival he soon com-
menced some light duties in a merchant's office and continued
well till the beginning of the month of May, 1885. During the

1Hunt, "Stammering and Stuttering," yth ed., p. 269.
1 "Aphasia and Other Speech Defects," pp. 73 ff.

214 THE PSYCHOLOGY OF STAMMERING

first three weeks of that month he suffered from a general erup-
tion of boils. On May 25, a very hot day, he went to see a
military review, and early in the evening did not feel well.
It was thought he had been slightly affected by the heat ; the
next morning he complained of pain in the back and left side
of his head. He had to leave the office about mid-day, not
feeling well, and the same thing occurred on the following day.
There was no actual sickness and fever, but he remained
rather unwell, keeping either to his bed or sofa till June 3, when
he went for a short sea voyage to Madras and back.

"He returned to Calcutta on June 21, and while at dinner
on that day suddenly became very excited and boisterous, and
had a convulsive attack of some kind (no details as to its
nature could be ascertained). For about a week after this he
was at times odd in manner, sometimes muttering to himself,
at others taciturn, with occasional twitchings of the muscles
about the face and shoulders. Then one day he suddenly lost
his speech, though his intelligence was unaffected. He under-
stood what was spoken or written, and could himself write
freely to express his wishes or in reply to questions.

"Nine weeks after this, having been completely dumb in
the interval, he was first brought to me, on September 4, 1885,
and he was then in the following condition. He was perfectly
intelligent, understood readily all questions that were put to
him, and wrote his answers freely and without any hesitation
or mistake. He could move his tongue and lips in all direc-
tions, but could not utter a sound. The tongue came out
straight. During the previous ten days (since his return to
this country) he had suffered a good deal from pains in the
left parietal and occipital region, and on two occasions had
twitchings on the left side of the face. When seen, on tapping
the head over the left posterior parietal region, there seemed
to be tenderness. There was no lack of symmetry or mobility

STAMMERING 215

about the face. The pupils were equal, of medium size, and
sensitive to light. The optic disks presented nothing distinctly
unnatural. There was some paresis of both upper extremities,
though this was most marked on the right side; his grip, as
measured by the dynamometer, being right 35, and left 47
pounds. Some distinct tremors of the right arm were noticed
while the instrument was being pressed with the left hand.
The knee-jerk on the right side was distinctly exaggerated,
both actually and as compared with that of the left side. There
was no lack of sensibility on either side of the face, trunk, or
limbs. Pulse 100, regular ; no cardiac bruit.

"September 9. A small blister to the nucha having been
ordered for the relief of the pains in the head, just after its
removal, on September 7, the patient had a convulsive attack.
He became rigid, made a guttural sound, had some slight con-
vulsions of limbs, and remained unconscious five to ten minutes.
Pulse to-day 104, regular. Tongue protruded straight, but
covered with white fur on the right side, tremulous.

"September 14. Pain in head now gone; no tenderness
on left side; bears tapping there without flinching. Right
knee-jerk still exaggerated.

" The patient after this date went to his home in the country
for six weeks, where he took six grains of iodide of potassium
with three minims of liquor arsenicalis three times a day, and
also a draught containing twenty grains of bromide of potas-
sium every night.

"November 26. During the first three weeks after his
return the patient had seven fits, but none since that period.
The total duration of each fit with subsequent stupor was said
to be thirty to ninety minutes. As far as I could learn, the
attacks were bilateral, associated with rigidity of limbs, or
rigidity and tremors, rather than with actual convulsions,
though sometimes these supervened towards the close. No

216 THE PSYCHOLOGY OF STAMMERING

headache now ; this disappeared soon after return. No twitch-
ings of face. Pupils equal, rather sluggish to light. No devia-
tion of tongue or lack of symmetry about face. No tenderness
to percussion anywhere over head. Knee-jerks now equal,
no exaggeration on right. Can walk ten miles without fatigue.
Grip much improved, but still weaker on right; right 70,
left 93 pounds. Optic disks healthy. Pulse 84, regular. There
was no improvement, however, in regard to speech ; I tried in
vain to make him utter simple sounds, even after faradisation
of throat and assuring him that he would then probably be
able to speak.

"December 2. Writes that yesterday he repeated to him-
self the whole of the vowel sounds, and also about twenty
monosyllabic words of three letters.

"December 4. Had a fit on the 2nd whilst at the dentist's,
just as he was beginning to inhale laughing gas. I tried to
induce him to read to me from a 'school primer.' He sat gazing
at the book for several minutes, some tremors and slight twitch-
ings of the facial muscles occurring while the efforts were being
made. At last he uttered two or three monosyllables in an
explosive fashion, at first very indistinctly in a sort of loud
whisper, but afterwards others more plainly and at short inter-
vals, not in quick succession. Thus, he uttered 'cup,' 'boy,'
'hat,' 'hog,' and afterwards read more currently these words:
'Let us go to the cow.'

"December 8. In the interval he has been practising read-
ing aloud, mostly when alone. I now made him try again to
read to me, and made this note : ' He sits gazing at the book,
with his hands between me and the upper part of his face;
but I can see his mouth plainly. His lips move, his breathing
is irregular, and he seems to be making efforts to pronounce the
words he sees ; but no sound comes till the expiration of four
and three-quarter minutes, when he said two words in a quick,

STAMMERING 217

explosive manner, followed at intervals of about a quarter of a
minute by two or three more words, and so on through a page
of Bell and Sons' "School Primer "composed of short monosyl-
labic words. Afterwards he tried to read another page more
continuously. This was done rather better, but was accom-
panied by much working of facial muscles and apparent effort.
His voice was cracked and squeaking in character/

"December 15. Previously I had never been able to get
him to repeat any words after me, nor to utter any words except
what he read in the book as above described ; but this morning
he repeated after me the following phrases : ' Good morning ' ;
'It is a foggy day ' ; 'If I go on like this, I shall soon go home.'
Each of these phrases was uttered after a moment or two of
delay, with facial quiverings, and then sudden commencement
after the fashion of a stutterer.

"December 30. He has not spoken to any one at home, but
he reads better and with less delay. Has been reading to his
sister and his mother. Reads more distinctly to me also.

"January 15, 1886. Hesitates and makes abortive stutter-
ing efforts for three seconds before he can say ' Good morning,'
and finally utters it very imperfectly. When set to read from
the 'School Primer' he began after one minute to read in a very
weak, cracky voice. He read a page in an indistinct and very
hesitating manner. Writes that he reads to himself daily, and
speaks to himself when he is alone. When told to utter his own
name, 'William,' he only pronounces it, after several abortive
trials, in a very indistinct manner. Has no pain ; sleeps well ;
appetite good. Grip right 77, left 77 Ibs.

"February 15. He went on fairly well till February 4,
though for some days previously, his sister informed me, he
had not 'seemed quite himself — in fact, from the date when
his father (thinking he was so much better) gave him, in ac-
cordance with his own wishes, some work to do, in the form of

218 THE PSYCHOLOGY OF STAMMERING

accounts and writing, in connection with his country estate.
About 7.15 P.M. on February 4, he was found by his sister in
a room alone and unconscious in an armchair. He had not
been in this room more than about fifteen minutes when he
was thus found. He remained unconscious rather over an
hour, having from time to time tremors over the whole of
the body, the right leg being extended, stiff, and with the toes
turned inwards. The right arm was also stiff, but in a flexed
condition. His face was dusky. Five days afterwards he
had another slight attack, a 'sort of fainting fit.' When over-
tired since, some twitchings have been noticed in the right
limbs. He has had no practice in reading or speaking since
the fit, and has been more listless in manner. Previously
he had been making some progress. He told me in writing
that, after commencing the work for his father, he began to
have pains in the left side of his head again, though these
pains were not worse on the day of the fit, nor had he been
over-fatigued on that day. He also said he had not been sleep-
ing well for two or three nights before the fit, having a few days
previously left off a bromide draught which he had hitherto
been taking every night.

"I did not see him again till October 9, when he was brought
to me by his mother. I learned that from early in June to the
middle of August he went away alone to a village in Derby-
shire, and lived at an inn there. One of his sisters then went
to stay with him, and found him somewhat better. He had
been at home for three weeks, and during this time has been
communicating with his mother orally, not having occasion to
resort to writing once. He has also been reading aloud daily.

" On examination, I entered the following particulars in my
case book: He complained of no pains hi his head, and has
no local tenderness. Appetite good; sleeps well. Pulse 88,
regular ; pupils equal and fairly sensitive ; face quite symmet-

STAMMERING 219

rical; tongue protruded straight; grip, right 90, left 117.
Knee-jerks slight, equal; no ankle clonus on either side. He
reads aloud much better than he did; begins without delay,
but reads with a weak, rather cracky voice, and with much ap-
parent effort and facial contortion a page from Humphry's
essay on 'Old Age,' the monosyllables of the school primer
being discarded. He speaks, too, in reply to questions, though
much more slowly and indistinctly than he should do. His
voice is husky; he articulates with much effort and facial
contortion, and after an explosive fashion, somewhat like that
of a bad stutterer. He was directed to practice reading several
times daily, uttering each word as distinctly as possible, and
also to resume doing some work for his father in connection
with his farm.

"After this I heard nothing till February 28, 1887, when I
received a letter from Dr. Phillips, in which he says in reference
to our patient, 'he has now quite recovered his lost faculty,
and is occupied in business in London. This result was not
hi any way sudden, but came about slowly and by continued
effort and tuition.' In short, he went on slowly but steadily
improving from the time I saw him last till he was sufficiently
well to enter his father's office hi London."

It will be noticed that the aphasia in this case
bears many remarkable points of resemblance to
stammering. In fact, at the time the patient was re-
acquiring command of language, the defect seems to
have been stammering pure and simple. At a time
when the patient had practically no command of
spontaneous speech he was able to read and repeat
with a fair degree of fluency. Again, the speech-
disturbance began with complete dumbness, a symp-

220 THE PSYCHOLOGY OF STAMMERING

torn that often accompanies the inception of stam-
mering.

The patient's ability to repeat suggests that the
cerebral defect was some minor disturbance in the
auditory centre. It will be noticed that there was
pain in the left parietal and occipital regions. Since
the auditory centre lies conterminous to both these
regions, it is quite likely that this centre was affected.
A lowered activity of the auditory centre would en-
tail difficulty in arousing the auditory images, and
hence would induce stammering. It is stated that
the patient spoke "with much effort and facial con-
tortion, and after an explosive fashion, somewhat like
that of a bad stutterer."

The patient's dumbness suggests that the cerebral
disturbance originally extended into the motor region.
Motor disturbances are likewise indicated by the
facial twitchings and the weakness of the right arm.
These conditions had practically disappeared, however,
before the mutism vanished.

The most striking feature of this case was the pa-
tient's ability to speak in solitude at a time when he
could not speak to other people. In a footnote
appended to the report of December 8, Bastian says :

"About this time, when he told me he had been repeating the
vowel sounds to himself, I said he should repeat them to some
one else, and he at once wrote : ' That is the difficulty. It seems
so stupid. I can do it when I am alone, but not to any one.' "

STAMMERING 221

It is chiefly on account of this feature that the
case has been cited. The ability to speak well in
solitude is one of the characteristics of most cases of
stammering. From the nature of the phenomenon
it is usually supposed to be dependent upon purely
psychological causes. But, as a matter of fact, there
are physiological causes that probably underlie the
psychological. During intellectual activity there is
a great increase in the amount of blood supplied to
the brain. During emotional activity the amount is
even greater. When abnormal pathological condi-
tions exist in the cerebrum, this increased blood-supply
probably interferes directly with consciousness.

Mosso has made a thorough investigation of the
cerebral blood-supply during intellectual activity,
emotion, and sleep. The results are recorded in his
monograph, "La Paura." l

In one experiment he employed a delicately balanced
table, on which his subjects were placed. So fine
an adjustment could be secured that the table
would vacillate with the subject's breathing. Mosso
affirms that the head-end of the table would descend
if the subject became engaged in intellectual activity ;
or if he even endeavored to fix his attention upon an
object. If the subject fell asleep, the table had to be

1 The excerpts quoted in this work are taken from the German
translation, "Die Furcht." There is also an English translation,
"Fear."

222 THE PSYCHOLOGY OF STAMMERING

readjusted on account of the recession of blood from
the brain. When the subject awoke, there was so
great an afflux of blood to the brain that the head re-
mained lowered if the balance were not reestablished.

Mosso showed by means of his plethysmograph that
the volume of the arms diminishes during intellectual
activity. This shrinkage of the arms is due to the
transference of blood from the body to the brain.
The shrinkage is, of course, general throughout the
body.1 In these experiments it was found that seem-
ingly insignificant causes — the entrance of a person
into the room, for instance — at once produced a
shrinkage of the arms, which the instrument auto-
matically recorded by means of tracings.

Mosso made similar tracings from the pulsations
of the heart. As one would expect, there was an
acceleration of the heart correlated with the change in
circulation and flow of blood to the brain. The heart
beat much more violently during emotional disturb-
ances. Further experiments showed that respiration

1 Thus Leonard Hill in his "Cerebral Circulation" (p. 74) : "An
anaemia of the central nervous system excites the vaso-motor centre,
and if the splanchnic vessels constrict, the blood pressure rises and
more blood is driven through the brain. The same result is pro-
duced by asphyxia. We have in the vaso-motor centre a protective
mechanism by which blood can be drawn at need from the abdomen
and supplied to the brain. At the moment that excitement from
the outside world demands cerebral response, the splanchnic area
constricts and more blood is driven through the brain."

STAMMERING 223

was also accelerated by emotion. The greater fre-
quency of respiration is probably a secondary phe-
nomenon. When the blood flows faster, more rapid
breathing is required for its oxygenation.

In another experiment, performed on three subjects
whose brains had been laid bare by lesions of the skull,
Mosso recorded the brain-pulse directly by tracings.
The investigations showed that the slightest intel-
lectual activity was accompanied by an increase in
the blood-supply to the brain. The brain actually
increased in volume, and its pulsations became more
vigorous. One day, while experimenting with his
female subject, he noticed a sudden strengthening of
the brain-pulse and an increase in the volume of the
brain for which he could detect no reason. Upon
questioning the subject he ascertained that she had
caught sight of a skull on the top of a cupboard, and
that this had induced a slight fear in her by reminding
her of her illness.

Mosso made tracings of the brain-pulse during
sleep. For long periods the pulse would remain reg-
ular but weak. Suddenly there would occur an
increased vigor in the pulsations and a dilation of the
brain, indicating, beyond doubt, the occurrence of
a dream. After a few fluctuations the disturbance
would subside, and the brain would shrink again to
its normal condition for sleep. During these ex-
periments, if the least noise occurred or if a light were

224 THE PSYCHOLOGY OF STAMMERING

brought near the subject, there followed the same
increased vigor of the brain-pulse. Calling the sub-
ject by name produced more violent disturbances,
but these likewise subsided if the subject were not
awakened. But if the subject were shaken so that
he gradually awoke, there occurred the characteristic
expansion of the brain and increased vigor in its
pulsations. As the subject fell asleep again, the brain
decreased in size and the pulsations again became
weaker and more rhythmical.
With regard to emotion Mosso says : l

"However, the changes in cerebral circulation produced
by fear are far greater. The reprimands and threats that I
cast at Bertino [the subject], when by moving his head or hands
he interfered with the experiment, and the disagreeable things
that I occasionally said with intention, invariably produced a
vigorous brain-pulse. The pulsations became six or seven
times greater than before, the blood-vessels expanded, and the
brain swelled and beat with such vigor that my colleagues
stared with astonishment at the photogram of the tracings."

From these facts it should be evident that there is
really nothing remarkable in the ability of a stammerer
or a mildly aphasic patient to speak when alone,
though he may be unable to speak in the presence of
other people. The mere presence of another person,
and the greater effort of attention required for con-
versation, causes an increased flow of blood to the brain ;
^'Die Furcht,"p. 73.

STAMMERING 225

and this, on account of existing abnormal cerebral
conditions, induces auditory amnesia. It is a note-
worthy fact that auditory images frequently occur
during sleep with persons that have no auditory
imagery during the waking state. This fact suggests
that the greater supply of blood to the brain during
the waking state results in a lowering of the activity
of the auditory centre. When the imagery is fuga-
cious during the waking state, it is probably expunged
by the cerebral plethora attendant upon increased
intellectual activity.

Temporary cerebral hyperaemia is probably the
cause of stammering in many cases where no organic
lesion exists. The cortex of the brain has an extremely
rich blood-supply; and any disturbance in the cere-
bral vascular system at once reflects itself in conscious-
ness. When the vessels become unduly distended,
auditory imagery is doubtless inhibited, and stammer-
ing results. If a mild organic lesion should exist, the
cerebral congestion would aggravate the condition and
thus produce disturbances in consciousness. Hence it
is possible for amnesia to supervene only when men-
tal activity exceeds a certain point. During mental
repose — when the person is alone, for instance — no
disturbance in speech appears.

The mental imagery is most likely to be obscured
when the subject is affected by intense emotion.
Under these conditions cerebral congestion is greatest.

226 THE PSYCHOLOGY OF STAMMERING

When temporary stammering or aphasia is induced
by stage fright or other emotions, it is probably due
to the excessive distension of the cerebral vessels.
The subjective condition is one of mental cataplexy.
When speech-defects are originally induced by emo-
tional shock, there is probably a rupture of some
of the finer vessels in the cortex.1 Rupture of the
larger vessels results in paralysis or death. This rup-
ture of the blood-vessels of the brain is known as
cerebral apoplexy.

Disturbances in consciousness are produced by any
abnormal condition in the cerebral blood-supply.
Cerebral anaemia is just as pernicious as cerebral
hyperaemia. In a person suffering from anaemia,
aphasia or stammering may occur because the blood-
supply to the brain is deficient. A stoppage in one
of the cerebral vessels will often cause aphasia by
inducing ischaemia, or local anaemia.

It will be seen from the foregoing pages that stam-
mering and aphasia are allied in a great many respects.
They are induced by the same causes. They mani-
fest many of the same symptoms — the occasional
ability of the subject to read fluently, to speak well
when alone, to speak fluently under the influence of

1 Ssikorski finds that emotional shock is responsible for stammer-
ing in practically three cases out of four. ("Ueber das Stottern,"
p. 232 and p. 235.)

STAMMERING 227

sthenic emotions, etc. They are both more common
in males than in females. And, finally, there is no
strict line of demarcation between them. Stammer-
ing often begins as mute-aphasia, and it is often suffi-
ciently severe at all periods of its manifestation to
be regarded as aphasia pure and simple. The specific
form of aphasia to which stammering is allied is
auditory amnesia, or auditory aphasia.1 It has been
demonstrated in numerous ways that the stammerer's
difficulty is due primarily to the failure of the audi-
tory verbal image, his difficulty manifesting itself
on that part of the word that cannot be readily pro-
duced kinaesthetically — i.e. on the vowel. When
the acoustic image is subtile and indefinite, he has
greater difficulty in recalling it. Hence, he more
frequently stammers on, or mispronounces, the short
vowels. When the auditory image is definite and
tangible, the stammerer can more readily recall it.
Hence he stammers little on the long vowels and rarely
hesitates in singing. When the primary auditory im-
age is clear, his difficulty vanishes. Therefore he
repeats readily, and speaks fluently in unison with
other persons.

Thus the arguments are practically conclusive in

support of the thesis that stammering is a form of

auditory amnesia. But since stammering has been

regarded by most investigators as some obscure and

1 Amnesia is the subjective condition ; aphasia rather the objective.

228 THE PSYCHOLOGY OF STAMMERING

undiagnosable form of subcortical motor aphasia, or
aphemia, it might be well to consider the arguments
against this latter theory.

If stammering were due to an organic lesion in the
neural mechanism actuating speech, it would often
be accompanied by some degree of hemiplegia. How-
ever, hemiplegia is almost invariably absent in stam-
merers. Even when the disorder is suddenly induced
by emotional shock, there is usually no symptom of
paralysis. The writer has seen only one case of
stammering (among approximately two hundred) in
which paresis existed. There was in this instance
a mild paretic condition of the right arm. But in this
case the speech-disorder could scarcely be classified
as stammering. The disturbance was of a motor
nature. There seemed to be difficulty in articulating
the consonants; but when these were pronounced,
the vowels were readily subjoined. Speech was
lethargic and heavy, and it had few of the usual
characteristics of stammering.

If stammering were a form of aphemia, it would be
impossible to effect even a temporary cure by elocu-
tionary methods, for elocutionary exercises can have
practically no effect upon those parts of the brain
that do not subserve consciousness. Yet more or
less transitory "cures" are effected by elocutionary
training in a few instances. The explanation for
the improvement in speech is probably that the

STAMMERING 229

vocal exercises effect a transitory intensification of the
auditory imagery.

The supposition that stammering is a form of aphe-
mia does not explain the stammerer's greater difficulty
with the short vowels. It does not explain his ability
to repeat and his ability to sing. To generalize, the
theory does not explain the stammerer's ability to
speak when he has a clear auditory image of the word
he wishes to utter. One might explain this ability
on the supposition that the stronger impulsion given to
the efferent current by a clear auditory image enables
it to overcome an abnormal resistance in the motor
cells or fibres. But even when this supposition is
made, the cause of the speech-defect — when the
subjective aspect is considered — still remains the
failure (or in this case the weakness) of the auditory
image. But the assumption that there exists an
undue sluggishness in the motor mechanism does not
explain the fact that the stammerer frequently pro-
duces a wrong vowel after his struggles to articulate
a word, and the fact that some stammerers experience
difficulty only with particular vowels. The existence
of a motor defect is disproved by the fact that the
stammerer has difficulty neither in articulation nor in
phonation. When consonants are followed by long
vowels he usually produces them with ease. He
never stammers on the consonants at the end of a word.
He has no difficulty in phonation, for he often vocalizes

230 THE PSYCHOLOGY OF STAMMERING

continuously on the continuous sonant consonants.
If the difficulty lies neither in articulation nor phona-
tion, it can scarcely be due to a motor disturbance.

Neither can there be a defect in the kinaesthetic
verbal memory-centre, for if such were the case,
the stammerer would have as much difficulty in sing-
ing as in speaking. He would stammer more on the
consonants than on the vowels, and would not articu-
late the consonants freely — as he does in stuttering
and many forms of stammering. In many cases the
stammerer would be hemiplegic. If there were a de-
fect in the kinaesthetic memory, the stammerer would
not be readily affected by slight differences in the
tangibility of the auditory image, and would not repeat
with his characteristic ease. — One might suppose, to
explain the effect of tangibility in the auditory image,
that the stronger sound-image arouses the associated
kinaesthetic image more promptly. If the kinaesthetic
image is the last provocative of speech, this associa-
tional process must of course occur invariably in the
audito-moteur, — though the awakened kinaesthetic
image does not come to the foreground of conscious-
ness, since the speaker attends to the auditory and
not to the motor image of the vowel. If the kin-
aesthetic image of the vowel-movements were suffi-
ciently strong to appear independently in conscious-
ness, the auditory image would be dispensable. In
a sense, then, one could attribute the stammerer's

STAMMERING 231

difficulty to a deficiency in his kinaesthetic imagery,
but this is only saying that the stammerer is an audito-
moteur rather than an articulo-moteur. If he were
an articulo-moteur, he would not be a stammerer.

There are cogent arguments against the existence
of a lesion in the fibres uniting the auditory and kin-
aesthetic verbal centres. A defect in either set of
fibres would not explain the stammerer's greater
difficulty with the shorter vowels. It would not ex-
plain his ability to repeat, to sing, and to read aloud
in unison with others. We might assume, again,
that the stronger auditory image overcomes an ab-
normal inertia, but we should still have to explain
the fact that the stammerer often produces the wrong
vowel and the fact that difficulty occurs in some cases
only with vowels of a particular coloration. The
assumption, moreover, would still leave the subjective
defect a failure (or weakness) of the auditory image.
It seems clear that this theory of the failure of the
auditory image is the only one that satisfactorily ex-
plains all the phenomena involved.

It is not at all difficult to explain the fact that the
auditory faculties are particularly vulnerable, — and
more liable to derangement than the motor faculties,
for instance. Hearing is one of the distance-receptors,
and is a more recent acquisition in the evolution of
the human race. It is one of the later terms in evolu-
tion, and hence is one of the earlier terms in dis-

232 THE PSYCHOLOGY OF STAMMERING

solution. The motor faculty is phylogenetically the
oldest, for the converting of a sensory stimulus into
a motor response is one of the primordial functions
of protoplasm. This motor function of the nervous
organism is therefore the least likely to be undermined.
The auditory function, on the other hand, is relatively
vulnerable ; and it is liable to derangement by even
a minor cerebral disturbance.

Taking the faculty of speech, we find that vowel-
color is phylogenetically and ontogenetically later in
development than pitch. Vowel-coloration is, in
fact, the last term in evolution, and is hence the first
term in dissolution. Pitch belongs to natural or
emotional speech; vowel-color belongs to artificial
language. Vowels express nothing in themselves by
their coloration. Their use in language (together with
consonants) is almost as factitious as the use of writ-
ing. Speech-sounds are merely so many symbols
arbitrarily associated with different objects and
actions in order that the latter may be designated.
Natural language, the language of pitch, is found in
most of the lower animals, and by means of it they
give expression to their emotions. Apes chatter to
each other or to an ape-audience ; but the sounds that
they emit are merely pitch-sounds that express their
feelings. In the language of the human child we find
that pitch precedes vowel-color. Musical recognition
and expression precede the recognition and expression

STAMMERING 233

of language. Long before the child has gained
command of language he is able to express anger,
fear, and affection by means of sounds of different
pitch. These sounds may have the same vowel-
color throughout : the child gives utterance to a series
of da's, for instance, but he expresses his feeling per-
fectly by means of the inflection. Pitch is thus older
than vowel-color in the development of both the race
and the individual. For this reason, appreciation of
pitch is less readily lost, and the aphasic patient may
understand and give utterance to pitch-sounds when
language is no longer expressed or understood. But
since vowel-coloration is the last term in develop-
ment, the memory and appreciation of vowel-qualities
is usually the first to be impaired, and these faculties
are disturbed by conditions that do not affect the
memory or appreciation for pitch. The fact that
vowel-coloration is the first term in the dissolution
of speech accounts for the position that stammering
holds as the commonest of all speech defects.1

Minor disturbances in faculties other than the
auditory and motor undoubtedly occur ; but they do
not affect speech, and hence give rise to no marked
objective symptoms.

1 Amnesia of pitch would not induce stammering even if this form
of amnesia were to occur. But the stammerer's difficulty does not
lie with pitch, for he produces pitch when stammering on the con-
tinuous sonant consonants — and the pitch, moreover, is usually
accurate.

234 THE PSYCHOLOGY OF STAMMERING

That stammering is an auditory disturbance is
borne out by the fact that it does not occur in persons
not dependent upon auditory cues. Stammering
seems to be entirely absent among the congenitally
deaf that have been taught to speak. Concerning
this matter, Hermann Gutzmann writes as follows:1

"It is well known that the congenitally deaf never stammer
— and in Germany, at least, they are all taught by the oral
method and gain a thorough mastery of speech. The reason
for this is manifest. In the first place, they learn speech under
the constant supervision of an instructor; and in the second
place, they learn to associate ideas with words only as they
slowly and progressively acquire mastery of the articulative
organs. The objection — which has been made — that there
are stammering children in institutions for deaf-mutes does
not affect the validity of the statement ; for it is certain that
these children are only hard of hearing or that they have be-
come deaf only after normal speech had been acquired. For
my part, I have never met a stammering child in a school for
deaf-mutes ; but I do not disavow the possibility of their exist-
ence, which is reasonable enough from the above point of view."

Dr. Gallaudet, President of the Columbia Institu-
tion for the Deaf and Dumb (Washington, D.C.), says,
in a communication to the writer :

"I have never known a congenitally deaf person who stam-
mered or stuttered."

Concerning the number of orally taught deaf persons
he has met, Dr. Gallaudet writes :

1 "Sprachheilkunde," 2d ed., p. 376.

STAMMERING 235

"I have been engaged in teaching the deaf for more than
fifty years, and have visited many schools in this country and
Europe. I must have met many thousands of this class of
persons."

Gutzmann's explanation for the deaf person's im-
munity — that he is more carefully taught and that
his speech and conceptual faculties develop concur-
rently — is certainly inadequate. The deaf person
is subject to all the usual inducing causes of stam-
mering, infectious diseases, shock, etc., and if there
were no more fundamental reason for his immunity,
he would certainly fall victim to the disorder as do
persons of normal hearing. The reason for his in-
vulnerability is undoubtedly found in his lack of
auditory imagery, and the consequent failure of a dis-
turbance in the auditory brain-centre to affect his
mental and oral speech. With most congenitally
deaf persons there is probably atrophy in the temporal
region, but this degeneration has, of course, no effect
upon consciousness.

In some cases of stammering the impairment of the
auditory imagery appears to be sufficiently severe to
entail a mild degree of word-deafness. Denhardt
says in reference to the stammerer's interpretation of
language : l

"With extraordinary frequency one observes in the stam-
merer a certain tardiness of perception, which is in no way due

1 "Das Stottern eine Psychose," p. 188.

236 THE PSYCHOLOGY OF STAMMERING

to lack of intelligence, but rather to lack of practice in, and in-
sufficient habituation to, the exchange of thought through the
medium of spoken language. It is as though the verbally
expressed thought required with the stammerer a longer time
than it does with the normally speaking person to reach the
seat of intelligence through the ear and to receive its interpreta-
tion."

The reader will recognize at once that Denhardt is
really describing a mild condition of word-deafness.
The occurence of a degree of word-deafness in stam-
merers is not surprising. The condition is one that
might well be expected to occur under circumstances
that oblige the stammerer to give oral expression to his
thoughts as well as to listen to the words of other
people. The necessity for speaking imposes upon him
a mental strain, which, with the attendant fear, is
sufficient to stifle the auditory imagery. There is
probably a condition of cerebral hyperaemia increasing
the inertia of the auditory cells; and this inertia
renders the cells almost as slow to receive auditory
impressions as they are to yield mental images.

But this word-deafness is not present solely during
mental excitement. The writer has remarked its
presence in stammerers during moments of complete
tranquillity. It usually takes the form of a tendency
to misinterpret vowels. To cite specific instances :
Camp was misinterpreted as Kemp; Woolley as Wyllie
(short y or i) ; man as men; pen as pin; sighing as
sewing, etc. In actual speech, the stammerer's vowels

STAMMERING 237

are often far from pure even when the impediment is
not in evidence. He is frequently misunderstood, or,
rather, un-understood ; and is consequently called upon
to repeat — much to his embarrassment. As regards
misinterpretation of vowels, it is certain that this
occurs with some degree of frequency in persons of
normal speech; hence it is impossible to say from
casual observation whether or not the phenomenon oc-
curs more frequently among stammerers. The matter
is one for investigation in the psychological laboratory.
Apparently the average non-stammerer is not re-
markably apt at interpreting sounds. When Wyllie
made his interesting experiments in the perception of
an apple through different senses, he tested a number
of persons by paring an apple with a table knife, hold-
ing it near the ear of the subject.

"Sixteen persons in all, mostly adults, were tried in this
fashion, and of the whole number only three answered correctly,
'You are paring an apple.' The others thought we were paring
wood, clipping paper with scissors, rubbing salt, rubbing two
surfaces of cloth together, etc." l

In view of these remarkable results it behooves one
to be conservative in drawing conclusions concerning
the relative ability of the stammerer to interpret sounds
and spoken language. The writer is, however, of the
opinion that a large proportion of stammerers manifest

'Wyllie, "Disorders of Speech," p. 228.

238 THE PSYCHOLOGY OF STAMMERING

some degree of word-deafness under such conditions as
induce severe stammering ; i.e. under conditions that
subvert the auditory imagery.

The writer has endeavored to ascertain the nature of
the mental imagery possessed by the average stam-
merer. The method employed was the circulation of a
questionnaire. A general description of mental im-
agery, similar to that given in Chapter I, accompanied
the question-forms, for most of the subjects had, un-
fortunately, little knowledge of psychology. The
questions employed were as follows : 1

1 The writer would appreciate replies to this questionnaire from
any of his readers that happen to be stammerers and have some
knowledge of psychology. A general description of the mental
imagery of each type would, of course, answer the purpose. In-
formation is desired especially in regard to the auditory imagery
and the verbal imagery. The motor imagery — especially of articu-
lative movements — is also important. If the reader should confine
himself to the questions here given, it might be well to observe
the following directions, which prefaced the questionnaire in its
original form :

"Read the questionnaire through before beginning to reply. Do
not trouble to repeat the questions ; refer to them simply by number.
Make your answers as complete as possible, avoiding where prac-
ticable such replies as Yes and No. If unable to answer a question,
state the fact frankly. Usually it will answer itself at some moment
when you are watching your thoughts.

"Be careful not to describe the image of a sensation that you
have just previously experienced. Such images, are, as a rule,
exceptionally vivid. Confine your description to images of sensa-
tions that have not occurred within the preceding five or ten min-

STAMMERING 239

QUESTIONNAIRE1

1. Think of some person who is well known to you, but whom
you have not seen for some little time. Do you clearly see the
features ; the outline of the figure ; the color of the clothes ?
Do you seem to see the person through a mist, or in a very
poor light ?

2. Have you a distinct memory for the scenes that you ob-
serve in daily life ? Do the objects appear to you in a clear
light, and with good definition? Are the colors natural?

3. Can you picture scenes described in a novel ?

4. How do your visual images differ from objects as you
actually see them ?

5. Imagine yourself brushing your hair. Do you distinctly
feel the arm-movements that you would employ ?

6. Can you in memory revive the hand-movements involved
in writing your signature ? Do you either hear or feel the
scratching of the pen upon the paper ? Does the performance
seem awkward as you imagine yourself writing with the left
hand?

7. Can you imagine the (touch) sensations that you would
get from handling a piece of sandpaper ; a wet cake of soap ;
a crisp, dead leaf ?

8. Can you mentally distinguish the feeling of a handful of
sand from that of a handful of sawdust? Can you, by your
memory for feeling, mentally distinguish silk from velvet; a
lighj; pin-prick from a deep pin-prick ; a snowball from a ball of
dough ?

utes. It is advisable to make these tests under conditions of quiet,
in order to facilitate concentration of attention. Closing the eyes
will frequently intensify the mental images."

1 Some of these questions are taken or adapted from standard
questionnaires.

240 THE PSYCHOLOGY OF STAMMERING

9. Can you imagine the feelings of different objects as you
think of yourself groping in the dark ?

10. Can you recall the odor of violets ; of cheese ; of tobacco-
smoke ; of frying bacon ?

11. Can you recall the taste of a lemon ; of salt; of sugar;
of some bitter substance, such as quinine ?

12. Can you imagine the scalding sensation from coffee that
is too hot to drink ? The coldness of ice-cream ?

13. Do you get an image of pain as you imagine yourself
slashing your wrist with a knife ?

14. Hold your hands as though about to clap them together.
Can you distinctly hear the sound that is about to occur ? Now
strike the hands together and compare the sound with your
auditory image. Was the latter clear and accurate ?

15. Hold your fingers ready to snap them. Can you clearly
think of the sound in this case ? Verify the image.

16. Go to the window and hold your hand as though about to
tap the pane with the knuckles. Can you distinctly imagine
the sound that is about to occur ? Verify by tapping the pane.
Was your image vivid and accurate, or were you totally unable
to think of the sound ?

17. Can you hear in memory the beat of rain against the
window-panes ; the crack of a whip ; a church bell ; the hum
of bees ; a train-whistle ; the chirping of sparrows ?

18. Can you call to mind instrumental music so that it gives
you pleasure ?

19. Can you, at will, imagine tunes on different instruments,
— the piano, flute, cornet, etc. ?

20. Do you play any instrument by ear ?

21. Do you sing to entertain friends ?

22. Do you frequently have tunes running through your
head ? If so, do you hear such tunes on an instrument, or do
you mentally sing them in words ?

STAMMERING 241

23. Can you mentally whistle a melody ?

24. Can you clearly recall the voices of your friends ? Do
you recall voices or faces more readily ?

25. As you read a letter from a friend, are the words in your
own voice, or unmistakably in the voice of the writer ?

26. Do you imagine a different voice for each character in a
novel ?

27. When thinking in words, do you hear them within your
head, or do you seem to be mentally articulating them; i.e.
speaking them with lips, tongue, etc. ?

28. Does your thinking voice resemble your speaking voice
in quality, volume, pitch, inflection, etc. ? or does the voice
appear to be nobody's in particular — a sort of standard think-
ing voice ?

29. Does the memory of your whispering voice seem to
differ from that of your speaking voice ? (Make the compari-
son on the normal inward breath, and not while exhaling.)

30. Open the mouth, and without moving the lips read
silently the following words: wobble, bubble, toddle, woman,
mimicry. Do these words appear thick and unnatural, as
though you were attempting to speak with the lips apart ?

31. Do you ever move the lips when reading silently?

32. Do you, when speaking, have visual images ("printed"
or "written") of the words that you utter?

33. Can you hear in imagination the barking of a dog?
The crowing of a cock? Do you clearly hear the sounds, or
does it appear that you are mentally saying them ? Are your
images unmistakable animal cries, or merely the conventional
"bow-wow" and "cock-a-doodle-doo"?

34. Imagine yourself tapping a tea-cup with a spoon. Can
you mentally hear the clinking sound ? Do you feel yourself
manipulating the spoon ? Are visual images present ?

35. Imagine yourself firing a revolver. Do you feel the

242 THE PSYCHOLOGY OF STAMMERING

weapon in your hand ? Do you feel yourself pulling the trigger ?
Is the report clear and sharp ? Do you mentally stand off and
see yourself performing the act? Are you able to do this if
you wish ?

36. When the word violin is suggested, do you think first of
the appearance of the instrument or of the sounds made when
it is played ?

37. Think of a train. What mental images are present in
the thought ?

38. Give your mental image-types in order of decreasing
intensity.

39. Give any supplementary information that may occur to
you in reference to your mental imagery.

Further questions were given concerning the rela-
tive difficulty experienced with long and short vowels,
and concerning the stammerer's ability to repeat
words spoken by others, to speak in unison with
others, to sing, etc. In every case the replies bore out
the statements already made in this chapter concern-
ing the various paradoxes of stammering.

Several of the subjects clearly indicated by their
replies that they had experienced the amnesia during
speech — and none of them, by the way, knew any-
thing of the theory the writer is advocating in the
present monograph. Two of the correspondents
stated that they found the mind to be absolutely
blank when they stammered. Had they been versed
in psychology, they probably would have said that
there was an occurrence of auditory amnesia. Most

STAMMERING 243

of the subjects stated, in reply to a question, that
they would intuitively recognize an unfamiliar word as
difficult — the name of a person or a town, for instance.
This means either that the auditory image disappears
during silent thought1 or that the kinaesthetic image of
the word is distorted. (The subject of distorted
imagery will be discussed later.) With an absolutely
strange word, it is more likely that the former con-
dition prevails.

The writer gives here a set of his answers to the ques-
tions. He finds it necessary to give his own answers
rather than those of his correspondents because, un-
fortunately, none of these subjects were trained in in-
trospection.

(i) The features, the outline, etc., are dim. The figure
appears as through a dark mist or as though seen on the outer
edge of the field of vision. The figure, however, is at the centre
of the mental visual field. There is practically no color in the
figure till I actually look for it. Then the colors are faintly
discernible. I can just distinguish them as I would distinguish
real colors in relative darkness.

1 The average stammerer will probably find upon introspection
that auditory amnesia not infrequently occurs during silent thought.
The auditory nucleus then drops from the word, leaving a kin-
aesthetic outline. This imperfect image is quite sufficient for
silent thought ; for it is the function of the word — its associations,
and not its intrinsic content — that is significant. But the image is
not adequate for oral speech. The speaker must know not
merely what the word means ; he must know, further, how the word
sounds.

244 THE PSYCHOLOGY OF STAMMERING

(2) My visual images of scenes are pictorial abortions.
The light is poor to the last degree, and the mental picture is
lacking in detail. The picture appears in light and shade
rather than color. I can introduce color only by an effort of
attention. Even then the color is not usually distinct.

(3) Scenes that I imagine are about as dear, or dim, in my
mind as scenes that I remember.

(4) The imagery .described in answers (i) and (2) is quite
typical. My visual images are commonly lacking in color and
detail, and the illumination is defective. In this respect
the miages are like pictures taken from a bad negative : they
show the contour and body of an object, but none of the finer
points. I find that the detail is brought out at a particular
point of the image only by direct attention to it. On the whole,
my visual miages are so vestigial that I almost wonder how I
think. Yet, when my visual images become detailed and
colored, as sometimes happens during extreme fatigue, I find
that the clear optical images are distracting. They seem to
divert the attention from the relations existing between them,
and thus they impede abstract thought.

(5) The arm-movements are almost as distinct as though I
actually made them. Mentally, I can execute almost any mus-
cular movement, and can "feel" the movement with great
clearness.

(6) I can feel the hand-movements with great distinctness.
I feel the movement of the pen over the paper, and feel the vari-
ations in pressure. The pen, however, moves silently. The
performance is just as awkward when I write mentally with the
left hand as when I do so in fact.

(7) All of these touch-sensations are very dear. My tactile
images are scarcely less vivid than my kinaesthetic images.
I can feel the sharp grains of sand as I handle the sand-paper.
I can feel the wet and slimy cake of soap, and by a movement

STAMMERING, 245

of the thumb and fingers can turn it over and over in my hand.
I feel the sharp edges of the leaf as I crumble it in my hand.

(8) I can make all of these distinctions quite readily. In
the case of the pin, however, I distinguish a mere touch from a
light pin-prick. I cannot get a very distinct image of pain as
I imagine the heavier pressure of the pin.

(9) These images occur with great vividness.

(10) The olfactory images do not appear to be very clear,
and I meet with little success as I endeavor to think of the odors
in the order mentioned, though for a moment I get a faint
mental image of the odor of the bacon. Olfactory images are,
however, sometimes quite vivid in my consciousness, and a
distinct image will occasionally rise without any overt associa-
tional connection.

(n) These gustatory images are not very clear, though I
get a fairly good image of the taste of the lemon. Taste-images
often seem to me to be quite intense, but I find upon analysis
that this is due in large part to the prominence of the tactual
element ; the actual gustative element is often relatively weak.

(12) The thermal images are fairly clear, though by no
means so strong as the normal touch-images.

(13) There is not a clear, localized image of pain, though I
distinctly feel the touch of the knife. The flesh seems to be
analgesic but not anaesthetic. The thought of cutting my wrist
is accompanied by a distinctly disagreeable element that seems
to take the form of a general chill.

(14) I can get absolutely no image of sound. I can mentally
feel and see the movements that my hands would make, and
can mentally feel the contact of the hands ; but I am deaf to
the sound that would occur.

(15) Utter silence.

(16) Ditto.

(17) I find it impossible to think of these things in terms of

246 THE PSYCHOLOGY OF STAMMERING

sound. The thoughts are visually represented. In the case
of the whip and the bell there are also motor images : I mentally
crack the whip and pull at the bell-rope. No sound, however,
supervenes.

(18) Am quite unable to recall instrumental music.

(19) Impossible.

(20) No.

(21) No.

(22) I can occasionally recall a tune; but this is often in-
accurate. I must always associate the tune with words. The
words I find to be auditory-motor.

(23) No.

(24) I find it practically impossible to recall voices. Some-
times I can associate the timbre of a person's voice with some
simple expression, such as "Good morning," or with a single
word like "Yes" or "No." In this case I find that 7 am saying
the word with the other person's voice ; i.e. I fed the word as
I hear it.

I of course recall visual images of faces more readily than
this.

(25) Always in my own thinking voice.

(26) The characters all have the same voice; that is, my
own thinking voice.

(27) I mentally feel the different speech-movements and
mentally hear the vowels. Occasionally I have an acoustic
image of a sonant consonant like m or n, but these images are
not very conspicuous.

(28) The acoustic element in my mental voice varies greatly.
Occasionally it possesses unmistakable timbre, and then the
timbre, of course, resembles that of my speaking voice. On
such occasions the volume, pitch, and inflection can also be
detected ; but these elements are felt as well as heard. When
the acoustic element in the voice happens to be weak, all timbre

STAMMERING 247

virtually disappears. The voice then loses its character and
becomes a sort of standard thinking voice ; i.e. it is predomi-
nantly kinaesthetic. But even under these conditions it possesses
pitch and inflection, these elements being represented to some
extent in terms of feeling.

(29) I find that the acoustic intensity of my voice is prac-
tically the same whether I mentally whisper, speak aloud, or
shout. The only difference detected is in the" effort" put
forth.

(30) The mental words appear thick and unnatural.

(31) Yes, occasionally; and especially if the lips should
momentarily be apart.

(32) These images do not usually appear; but by an act
of conscious attention I can arouse visual images of words
fairly readily. But though these images appear promptly, they
are not at all distinct.

(33) I am mentally saying the words. The words are audi-
tory-motor.

(34) I can picture the scene and can mentally feel myself
manipulating the spoon. I can feel and see myself striking
the teacup, but I do not get an image of the sound.

(35) I see my arm before me and see the weapon in my hand.
I distinctly feel the revolver and feel myself pulling the trigger.
I can see the smoke and can feel the "kick," but I do not hear
the sound. Now I can mentally stand off and see myself go
through the performance. The image is about as clear — or
dun — as any other visual image, but I have no trouble
in redintegrating it. The revolver is again of the noiseless
type.

(36) I think of the appearance of the instrument. I cannot
think of its sound.

(37) I am standing about a hundred feet from the railway,
and I see the train go rapidly and silently past me. I can see

248 THE PSYCHOLOGY OF STAMMERING

the contour and body of the train, but I see practically none of
the details unless I look for them individually.

(38) Motor and Tactile.
Visual.

Thermal and Algesic.
Gustatory.
Olfactory.
Auditory.

(39) Although my visual images are vestigial, I find that
they predominate in my thinking. Much of my abstract thought
proceeds in visual imagery. These visual images are often
diagrammatic, and various parts of the image or various images
then move in such a manner as to express relations. Often
the relation is expressed by an eye- or hand-movement in motor
terms. Very little abstract thought seems to occur in verbal
imagery. I can usually think more freely and more rapidly
if I do not stop to express my thoughts in words.

I not infrequently experience strong auditory images during
dreams, and I have found these images to occur during fever.
But during the waking state no sound-image enter my con-
sciousness except the sound-images associated with my verbal
thought.

It is somewhat difficult to say whether the lack of
auditory imagery indicated by these answers is char-
acteristic of the average stammerer. The writer is
inclined to believe that such is the case. Very few
stammerers possess a "musical ear." Charles Lamb
probably spoke for the majority of stammerers when
he said, " Sentimentally, I am disposed to harmony;
but organically, I am incapable of a tune." Among
approximately two hundred stammerers the writer

STAMMERING 249

has known only two that were able to sing without
disgracing themselves.1

Several writers have remarked the defective ear of
the stammerer. Klencke says:2

"I put notes by the side of the vowels to indicate the key
in which they are to be produced. By so doing, the patient
acquires the use of his voice in its full compass and cultivates
his ear for the tone, in distinguishing which nearly every stutterer
[stammerer] is defective."

And thus Albert Gutzmann : 8

"If a child cannot distinguish a high from a low tone by the
ear (I have often found that with adult stuttering persons) he
may put his hand on the larynx of the teacher or of another child
and notice the difference by feeling, for the larynx rises for the
higher tones and sinks for the deeper ones."

Not every stammerer, however, is lacking in general
auditory imagery. The replies to the writer's ques-
tionnaire 4 show (if they may be regarded as reliable)
that the imagery is sometimes fairly strong. As re-
gards the acoustic imagery of ordinary physical sounds
and music, the replies exhibited the two extremes as
well as the different degrees between them. In some
cases there was no memory whatever for ordinary

1 One of these had incurred his impediment through imitation.

1 The Voice, Vol. I, p. 112 (from a translation of "Die Heilung
des Stotterns").

1 Albert Gutzmann, "The Cure of Stuttering" (The Voice, Vol. V,
p. 83). * About two dozen sets of answers were received.

250 THE PSYCHOLOGY OF STAMMERING

sounds, and in other cases most sounds were appar-
ently represented.

There seems, however, to be no necessary parity
between the acoustic memory for ordinary sounds and
the acoustic memory for words. Ballet says in refer-
ence to this matter : *

"We know a distinguished musician that is endowed with a
remarkable memory for sounds; but he recalls words by in-
voking his visual rather than his auditory memory."

The existence of clear musical imagery or clear
general auditory imagery does not therefore necessarily
indicate the existence of a clear auditory memory for
words.

The writer's correspondents were unanimous in the
statement that they both heard and felt their words
when thinking them. The acoustic element seemed
subject to a good deal of variation, some correspond-
ents stating that the thinking voice resembled the
speaking voice in timbre, volume, etc., and others
stating that verbal thought took place in "a sort of
standard thinking voice"; i.e. in a voice in which
the acoustic element must be decidedly weak. All
agreed, however, that the acoustic element was pres-
ent. This, of course, is exactly what one would
expect.

But it seems probable that the average stammerer

1 "Le langage int&ieur et 1'aphasie," 2d ed., p. 28.

STAMMERING 251

has weak rather than strong auditory verbal imagery.
It would not be surprising to find that this imagery is
relatively strong in a small minority, for the stam-
merer's difficulty is not occasioned by deprivation
or weakness of the auditory imagery, but by tran-
sient auditory amnesia. The stammerer has audi-
tory imagery, and he relies upon it in speech.
Even after the occurrence of the amnesia, the
acoustic image must ultimately appear; for if
this were not the case, the stammerer would be
permanently aphasic. The imagery may, then, in
some cases be strong (though one must be conservative
in interpreting the statements of non-psychologists) ;
but the amnesia may appear, none the less. The in-
ducing cause of stammering — the emotional shock,
fever, or whatever it be — may effect not so much a
general enervation of the auditory verbal centre as a
functional perversion that renders transitory amnesia
likely to supervene. But if this were the case, it
would be the person with congenitally weak auditory
imagery that would be most likely to suffer. The
weakness of the imagery would itself be a predisposing
cause. It would render the amnesia more liable to ap-
pear and more difficult to overcome. For this reason
one is impelled to the belief that the average stam-
merer has weak rather than strong acoustic imagery.
The weakness of the imagery is probably in most
cases a congenital rather than an acquired defect, the

252 THE PSYCHOLOGY OF STAMMERING

acquired defect being a functional perversion that at
times subverts the imagery that is already dangerously
near the point of extinction. When the imagery is
congenitally strong, the same functional defect might
merely lower its intensity without affecting oral speech.

It would be quite possible, though, for a general
weakening of the auditory imagery to induce stammer-
ing. The stammering would be more likely to appear
if there existed a neurotic tendency that rendered
the intensity of the imagery variable. The imagery
would then vacillate near its minimum intensity and
would repeatedly disappear from consciousness. The
combination, weakness of imagery and variability in
intensity, would be sufficient to occasion stammering
in any person dependent upon auditory cues ; and if
either of these causes were extraneously introduced
when the other was already existent, the impediment
would be established.

It is also quite conceivable that a general enervation
of the auditory verbal centre might induce stammering
even if there existed no marked tendency to variability
in the imagery. The general lowering of the intensity
of the auditory imagery would probably entail oblitera-
tion of some of the less distinctive vowel-colors, and a
somewhat equable form of stammering would result.
This cause is probably operative in some cases where
temporary stammering occurs during the course of a
disease or during the succeeding convalescent period.

STAMMERING 253

Variability in the intensity of mental imagery is
normal, though extreme or sudden variations probably
occur only when there exists a neurotic tendency or
some cerebral functional perversion.

Angell says of the normal mental imagery:1

" To-day this may be principally auditory and verbal, to-mor-
row largely visual. It may be on the one occasion vivid and
detailed, and on the other evanescent and wholly schematic."

Changes in the verbal imagery are likewise normal and
common. In his "Motorische Wortvorstellungen,"
Dodge describes the mutations in the verbal imagery
of a theological student. The imagery was generally
auditory-motor, but at times it assumed a purely
auditory form :

"One day he told me that his verbal imagery had been
purely auditory during the course of the preceding evening.
Not the slightest trace of movement-images was present.
This he had determined during a period of quiet introspection.
At the time that he made this communication to me, the motor
element was again the prominent, and apparently the exclusive,
[?] constitutent of his mental speech. He informed me on
subsequent occasions that the motor element in his verbal
thought would sometimes completely disappear for several hours.

"He was not able to produce this change in the character
of his verbal imagery at will. The auditory verbal imagery
seemed to confine itself to hours of quietness and repose. Apart
from this, no regularity could be observed." *

1 "Psychology," p. 253.

•"Motorische Wortvorstellungen," p. 36.

254 THE PSYCHOLOGY OF STAMMERING

It is probable that the motor images disappeared
when the auditory images became sufficiently intense
to represent the verbal thought independently. This
particular case shows only the intensification of the
auditory imagery. Its obfuscation may or may not be
common among persons of normal speech ; but it is
certainly common among stammerers. A correspond-
ent says, in reply to the questionnaire :

"When thinking in words, I sometimes hear them and some-
times seem to be mentally articulating them. When my speech
has been annoying me, I always think in the latter way." l

The latter remark suggests that failure to hear the
words was the cause of the stammering. The remark
is significant: it supports the belief that a general
obfuscation of the auditory imagery renders the amnesia
more liable to appear and more difficult to overcome.

The increase or decrease in the intensity of the men-
tal imagery may endure for hours, days, weeks, or
months. The mutations are primarily attributable to
minor changes in the physical condition, — physical
changes in the nervous system that do not always
manifest themselves in definite feelings. Fatigue,
sleeplessness, or an attack of indigestion may
obfuscate the mental imagery, and the stammerer
finds that for some unaccountable reason he is ex-
periencing greater difficulty in speech. On the other

1 The correspondent knew nothing of the theory advanced in this
monograph.

STAMMERING 255

hand, the tone of the nervous system may tempora-
rily improve, and forthwith the auditory imagery is
intensified. All traces of the impediment may disap-
pear, and for a time the stammerer enjoys complete
immunity from his defect. If the improved tone of
the nervous system is due to a change of climate, the
stammerer may have no difficulty in speech for weeks
or months at a time. But the speech-disorder re-
curs as soon as he becomes acclimated, or as soon as
some minor physical disturbance adversely affects
him.

These mutations in speech-disturbances may or
may not be due exclusively to the vicissitudes of the
auditory imagery, but certainly they are attributable
to them in large part.

The desideratum in speech is either strong auditory
imagery or no auditory imagery at all. The strong
imagery renders one immune from speech-disturbances
when slight variations in its intensity occur; the
absence of the acoustic imagery renders variation im-
possible. It is the fugacious and vacillating auditory
imagery that causes the stammerer's trouble. The
auditory imagery is always, as it were, in unstable
equilibrium. The sound-image is continually disap-
pearing from consciousness, and the stammerer is left
struggling for a foothold in space.1

1 The reader that is a non-stammerer can readily comprehend the
nature of a fugitive image by watching the gradual evanescence of a

256 THE PSYCHOLOGY OF STAMMERING

It is interesting to note that many authorities regard
stammering as an hereditable defect. Wyneken says
on the matter : 1

"One cannot escape the fact that there exists in many cases
a certain inborn predisposition to stammering, which cannot
be eradicated by the most careful training."

Denhardt regards stammering as inheritable.
Among 1994 cases of stammering he found evidence of
heredity in 1545; that is, in approximately 77! per
cent.2

Doubtless many cases of stammering ascribed to
heredity are in reality due to unconscious imitation.

visual after-image. Let him take a small square of red paper and
place it upon a white background. Let him then fixate a pin-prick
at the middle of the square for 15 or 20 seconds. When the square
is removed, a green after-image will appear upon the paper.

This after-image assumes various degrees of vividness. At first
the outline is well defined, and the color intense. Gradually the
sharp boundaries disappear, the angles vanish, and the contour is
obliterated. Simultaneously the color fades, and finally nothing
remains but a dim, colored haze. In its turn, this haze disappears,
and the after-image has vanished.

This after-image may be regarded as illustrating the various
degrees of intensity in auditory images. The ideal auditory image
for the incitation of speech is the one analogous to the square with
its sharpest outline and coloration. The image as it exists in many
persons — and probably in most stammerers — is comparable
to the after-image shortly before its disappearance. The amnesia
of stammering is represented by the visual blank by which the image
is succeeded.

x"Ueber das Stottern und dessen Heilung," p. 10.

1 "Das Stottern eine Psychose," p. 91.

STAMMERING

257

But this explanation will not hold in all cases, for
often there is no association between the related stam-
merers. In the latter cases there is probably an
inherited weakness of the auditory imagery or an in-
herited neurotic tendency entailing marked variability
in the imagery. Either of these factors would predis-
pose the child to stammering ; and if the other factor
should supervene, the speech-disturbance would be
established. In some cases it is probable that both
factors are inherited — though not necessarily
from the same parent; and the child might then be
said to inherit his stammering.1 The stammering
might not develop if the neurotic tendency were to
manifest itself at an early age, for the child would then
probably learn to depend upon his kinaesthetic imagery.
But if the neurotic tendency were not displayed till
the child had acquired command of language, stam-
mering would inevitably ensue.

The form of stammering that has been considered
up to this point is pure stammering; i.e. stammering
directly due to auditory amnesia, and uncomplicated
by extraneous symptoms. The blind struggles of the
stammerer — the facial contortion and physical effort
— are mere epiphenomena. They are secondary

1 Davenport gives pedigrees of two stammering families in his
"Heredity in Relation to Eugenics." He inclines to the view that
stammering is a recessive characteristic. It is probably incorrect,
however, to regard stammering as a unit character.

258 THE PSYCHOLOGY OF STAMMERING

manifestations of the defect. This latter form of
stammering may be designated secondary, or physical,
stammering. The third form of the defect, acquired
kinasthetic stammering, is due, like the first, to mental
causes. It is stammering occasioned by perversion or
distortion of the mental imagery of speech. This per-
version of the verbal imagery may result from as-
sociation with or imitation of other stammerers, or it
may arise as the direct result of one's own stammering,
the process being, as it were, one of auto-intoxication,
or self-infection.

We shall now consider the characteristics of these
forms of stammering a little more closely.

PURE STAMMERING

The forms of stammering directly due to auditory
amnesia may be roughly classified. The classifica-
tion is of no particular value except that it serves to
establish one's conception of pure stammering.

When pure stammering manifests itself on the con-
tinuous consonants, it usually takes the form of a pro-
longation of the initial sound. In the word few, for
instance, a continuous fricative sound is produced till
the vowel appears. If the initial consonant happens
to be sonant, a continuous vocalization accompanies
its production. Strictly speaking, the vocalization is
part of the consonant, for without vocalization the
consonant would be surd. It sometimes happens,

STAMMERING 259

however, that the "sonant" consonants are produced
without voice. This surdal stammering on the con-
tinuous sonant consonants can be regarded as pure, for
the prolongation of the consonant is directly due to the
auditory amnesia.

A form of interruptive or repetitive stammering
some times occurs on the continuous sonant consonants.
This form of the defect is frequently "diagnosed" as
stuttering. It is evident that the distinction between
stammering and stuttering is artificial. Repetitive
stammering is not due to disturbances in respiration
or to occlusions of the glottis, but rather to the execu-
tion of articulative movements that are not directly
succeeded by the vowel. The stammerer attempts
to say six, but produces a series of short sibilant
sounds. The word then becomes s-s-s-six. He at-
tempts to say London, but repeatedly articulates a
surdal or sonant L. In both cases the stuttering
articulation is directly occasioned by failure of the
auditory image. Occasionally a silent pause occurs
between the consonant and the vowel. This form of
stammering rarely appears, however, on the con-
tinuous consonants.

All other forms of stammering on continuous con-
sonants, such as manifestation of lingual or labial
effort, must be regarded as secondary.

There are three different varieties of pure stammer-
ing on the explosive consonants. The first variety is

260 THE PSYCHOLOGY OF STAMMERING

the disjointed speech described by Kussmaul, in which
there is a distinct lacuna between the consonsant and
the vowel. Instead of saying Kommen and Kaffee,
the speaker says K — h — ommen and K — h — affee. He
articulates the consonant, — using kinaesthetic cues, —
then waits passively for the auditory image to appear.
This particular form of stammering exactly reflects
the verbal image of the word. It is the purest form of
stammering that can occur on the explosive consonants.
In the second form of stammering on explosive con-
sonants the articulatory organs are held passively in
position till the auditory image rises in the mind.
The word is articulated as soon as the sound-image ap-
pears, and no marked incoordination is perceptible to
the ear, — a delay only is heard. The stammering ap-
peals chiefly to vision ; it can be seen that the articu-
latory organs take their initial position and hold it
for an abnormal length of time. This form of stammer-
ing is really somewhat of an accomplishment : it is the
stammering of the virtuoso. The stammerer essays
to retard the consonant — without repeating it, or
"holding" it with undue pressure — till the vowel is
ready to appear. The difficulty is, however, that the
stammerer cannot always tell just when the vowel is
ready to appear ; and when he produces the consonant,
he may find that his articulation has been premature,
and before he finally gets the vowel, the stammering
may be decidedly evident.

STAMMERING 261

The third variety of stammering on the explosive
consonants takes the repetitive form. The sonant
consonants are sometimes produced as surdal, but the
surd consonants are practically never vocalized.

This exhausts our classification of pure stammering.

The assertion is made by some writers that stam-
mering occurs more frequently on the explosive con-
sonants than on the continuous consonants. The
disparity is slight, if it exists. There seem, however,
to be mechanical and psychological reasons why
greater difficulty should be experienced in subjoining
the vowels to the closed consonants ; hence, if stammer-
ing does occur more frequently on these consonants,
the fact need not indicate that the consonants them-
selves are difficult.

When a word commencing with a sonant explosive
consonant (B or D, for instance) is articulated,
vocalization commences in advance of articulation.
When the articulatory movement is produced, the
vowel must follow instantaneously; otherwise stam-
mering results. Vocalization is already under way,
and the vocal stream must be shaped immediately
to the appropriate vowel. With the surd explosive
consonant (P or T, for instance), no less dexterity is
required. The consonant is exploded by a non-
vocalized stream of breath ; but as soon as articulation
takes place, the stream of breath must be vocalized

262 THE PSYCHOLOGY OF STAMMERING

and given its requisite color. If for any reason the
latter process is delayed, stammering results. It is
evident, then, that for fluent enunciation of words
commencing with explosive consonants, the auditory
image must be at the instant command of the speaker.
The slightest delay in its appearance produces abnor-
mal speech.

So delicate a control of the vowel is not required for
the continuous consonants. The speaker commences
the initial consonant — a V or an M , for instance —
and sustains it till the vowel appears. Instantaneous
production of the vowel is not necessary, for it makes
no difference whether the consonant be continued for a
fiftieth part of a second or for a whole second. Hence
a less delicate control of the auditory image is re-
quired. If the vowel is delayed for a half a second, the
consonant is continued so much longer. The contin-
uous consonants can be continued, but the explosive
consonants can not. If the vowel is delayed for a half
a second with the closed consonants, stammering must
inevitably result.

These facts should account for whatever disparity
exists in the amount of difficulty experienced with
the two forms of consonants. There is another fact
that might account for the more frequent occurrence
of stammering on the closed consonants. Physical
stammering is usually greater on these consonants ;
hence they are more likely to be affected by acquired

STAMMERING 263

kinaesthetic stammering due to distortion of the mental
imagery. This matter will be better understood after
the subject of distorted imagery has been more fully
discussed.

SECONDARY, OR PHYSICAL, STAMMERING

It will be noticed that up to this point practically
nothing has been said concerning labial and glottal
" spasms," " paroxysms of stammering," etc. These
"spasms" constitute nothing more nor less than the
stammerer's misdirected efforts to overcome his
difficulty. They are often regarded, however, as the
primary defect. The following paragraph exhibits a
fairly typical point of view :

"The most distressing cases are those in which the spasm
extends to parts unconnected with speech, — it may be to
nearly the whole muscular organism. In such a case the
spasm commences, let us assume, at the base of the tongue;
the mouth opens widely and remains in that position; the
muscles of expiration work convulsively ; the glottis contracts ;
respiration becomes arrested ; the face becomes congested and
the veins dilated; violent spasmodic movements involve the
trunk and limbs ; and only after some time, either when the
patient becomes exhausted, or when he resolutely restrains
his attempt to articulate, does his paroxysm come to an end." 1

These " spasms " are, of course, neither the stam-
mering nor the cause of the stammering. Strictly
speaking, stammering is little more than a failure of

1 "Quain's Dictionary of Medicine," ist ed., p. 1513.

264 THE PSYCHOLOGY OF STAMMERING

speech due to the non-appearance in consciousness of
the auditory image. It is the inability to complete a
word that may or may not have been begun. The
primary disturbance is essentially passive. The
"spasms" and contortions are nothing but an excres-
cence on the disorder. They are the blind and impo-
tent struggles of the stammerer against an invisible
adversary. Physical stammering is purely volun-
tary. It is not always deliberate : it is often the prod-
uct of bewilderment. But it is voluntary in this
sense — that it can at any moment be inhibited.
Often the stammerer summarily relinquishes the at-
tempt to speak, and thereupon the so-called paroxysm
is at an end. Physical stammering is occasioned
solely by the speaker's ignorance of the real nature
of the disturbance. When the vowel-image fails to ap-
pear, the consonant is either not articulated or it is
rapidly repeated. Hence the stammerer sees in the
consonant the apparent cause of his difficulty, and
resorts to physical effort to overcome it. He presses
the lips together, tightens the muscles of the throat,
clenches the fists, and may work even his arms and
legs in an effort to articulate. But, since articulation
itself causes no difficulty, his efforts are entirely mis-
directed.

Physical stammering may, in many cases, lead to
obfuscation of the verbal imagery. A case is on
record in which a subject could stop his internal

STAMMERING 265

language by simply holding the breath.1 The average
person with marked kinaesthetic images of speech
will find that the act of inhibiting respiration restrains
the internal language. Thus it is clear that physical
stammering may aggravate the amnesia.

The brain expands more during expiration than dur-
ing inspiration.2 This being the case, it is evident
that the common practice of stammerers of exhausting
the breath may increase cerebral congestion, and thus
likewise aggravate the amnesia that directly induces
stammering.

The secondary manifestations of stammering are so
multiform that the task of classifying them would be
arduous to the last degree. The writer has no in-
tention of undertaking the task, for the work would be
worthless when complete. Ssikorski has written a
chapter on the symptomatology of stammering, and
he commences it as follows : 3

"The manifestations of stammering are so varied and com-
plicated that the investigator engaged on this neurosis must
perforce ask himself whether there exists a single disturbance
or a number of disturbances that have been grouped together
on account of insufficient analysis. The external manifesta-
tions are so diverse that it seems impossible to compare and
classify the symptoms of the different cases."

1 Annales Psychol., January, 1893, p. 103. (Quoted by Baldwin,
"Mental Development of the Child and Race," p. 434.)
2 Leonard Hill, "Cerebral Circulation," p. 13.
1 "Ueber das Stottern," p. 44.

266 THE PSYCHOLOGY OF STAMMERING

The succeeding 143 pages of Ssikorski's monograph
contain his attempt to correlate the various "spasms"
that occur in stammering. All the different " spasms "
are classified and described — from those in the upper
lip to those in the lower extremities. The work is a
monument to the author's thoroughness and patience,
but its value is unfortunately negligible.

A remark may be made at this point concerning the
frequent self-exacerbation of physical stammering.
It will be remembered that a muscular movement is
initiated by a mental image of its resident or remote
effect. The resident effect is the kinaesthetic sensation.
If this resident sensation gets to the focus of attention
during the mental hiatus occasioned by the auditory
amnesia, it may, apparently, augment the muscular
contraction by assuming the function of the inciting
image. The excessive muscular contraction that
results constitutes a pseudo-spasm; and it is this
"spasm" that has led the objective observer astray.
But, as already stated, there is no spasm in the real
sense of the word. At any moment the will can step
in and inhibit the process. All that is necessary is
that something other than the kinassthetic sensation
be placed at the focus of attention. To secure this
condition the stammerer has often to relinquish the
attempt to speak.

The following paragraph gives James's account of

STAMMERING

267

the manner in which a sensory stimulus normally
brings about a motor response. (Figure 6, to which
the letters refer, represents the nervous system re-
duced to its fewest possible terms.)

Motor Cell

Muscle «^

Sensory Cell

Kinaesthetic Cell

FIG. 6.

"A stimulus reaching the sense-organs awakens the sensory
cell, S; this by the connate or instinctive path discharges the
motor cell, M, which makes the muscle contract; and the
contraction arouses the second sensory cell, K, which may be
the organ either of a 'resident' or 'kinaesthetic,' or of a 'remote'
sensation. The cell K again discharges into M . If this were
the entire nervous mechanism, the movement, once begun,
would be self-maintaining,1 and would stop only when the parts
were exhausted. And this, according to M. Pierre Janet, is
what actually happens during catalepsy." *

Each elementary movement must be regarded as
possessing its own motor circle. The complex move-
ments required for the articulation of a word would
involve several motor circles.

1 This circle of neural activity James calls the "motor circle."
1 James, " Principles of Psychology," Vol. II, p. 582.

268 THE PSYCHOLOGY OF STAMMERING

In regard to the continuous discharge through a
a motor circle, James says : l

"We should all be cataleptics and never stop a muscular
contraction once begun, were it not that other processes si-
multaneously going on inhibit the contraction. Inhibition is
therefore not an occasional accident; it is an essential and
unremitting element of our cerebral life."

The inhibition is brought about by the transference
of attention from one term to the next in a concate-
nated series. The attention is always directed toward
the ultimate result to be achieved, and the completion
of one elementary movement is the signal for attention
to move on to the next. If, however, one of the
members of the series fails to appear — the remote,
auditory image of the vowel, for instance — the ac-
tivity in the preceding motor circle is unduly pro-
longed; and if the kinaesthetic sensation from the
movement comes to the focus of attention, the
muscular contraction may be greatly intensified. In
fact, the stammerer may be able to inhibit activity
in the motor circle only by relinquishing the attempt
to speak.

The foregoing is an attempt to explain in a rather
elementary way the rationale of a pseudo-spasm. No
attempt has been made to solve the question as to
what length the muscular contraction can be automati-
cally continued after it has been voluntarily begun.
1 Loc. tit., p. 583.

STAMMERING 269

The attempt would lead to an almost interminable
discussion concerning theories of different "levels" of
attention. The discussion itself would lead nowhere ;
hence it is best omitted. It is certain that activity
in the motor circle is voluntarily initiated, and that it
can at any moment be voluntarily discontinued. The
whole subjective aspect of the matter can be summa-
rized in the statement that the wrong element gets to
the focus of attention. Instead of the verbal image of
a word, there is placed at the focus of attention a
kinaesthetic sensation of muscular contraction. This
abnormal condition intensifies the physical stammer-
ing.

But, let it again be emphasized that the pseudo-
spasm is purely a secondary manifestation of stammer-
ing, and is never the cause of the defect. It is itself
indirectly induced by the failure of the auditory
image; but when the auditory image appears, the
pseudo-spasm is at an end.

STAMMERING DUE TO DISTORTION OF THE VERBAL
IMAGERY

In some cases the afferent sensations from physical
stammering impress themselves upon the memory of
the stammerer and distort his verbal imagery. His
verbal images of words are then perverted by kinaes-
thetic images of labial or lingual pressure, or by
images of recurring articulation. It can therefore be

270 THE PSYCHOLOGY OF STAMMERING

said with truth that it is in certain cases more difficult
for the stammerer to think some words than it is for
him to think others; his difficulty is not necessarily
confined to their enunciation. In thinking, he may
find that his verbal imagery is at times somewhat con-
strained by the disappearance of the auditory nucleus ;
but this imagery may be also encumbered by mental
feelings of muscular effort and labored articulation,
the consonant appearing in thought much as it appears
in speech. It is probable that this articulatory
stammering occurs in the mental words of the amnesic
stammerer only when the auditory image fails to
appear in the mind. It would be the invariable
concomitant of a particular mental word if the word
invariably occasioned difficulty. However, the
stammerer usually has difficulty only under certain
conditions; hence he may speak a word fluently
more frequently than he stammers upon it, and the
sensations from stammering are offset by the more
frequent feelings of free articulation.

The replies to the writer's questionnaire show that
mental stammering exists in a majority of cases.
The correspondents were not asked, however, to
differentiate kinaesthetic stammering from auditory
amnesia. Either phenomenon is mental stammering,
but the average non-psychologist could not be expected
to give reliable information concerning the extent to
which the conditions exist independently of each other.

STAMMERING 271

The voluntary imitating of stammering or stuttering
at times effects a perversion of the kinaesthetic and au-
ditory verbal imagery. Since the verbal image is par-
amount in determining the nature of the spoken word,
the simulant then becomes a stammerer in reality, and
pays the penalty for his folly by serving as a butt for
other witlings. When stammering is induced by imita-
tion, it does not assume the amnesic form ; the speech-
derangement is occasioned by the distortion of the
verbal imagery, and not by failure of "internal
hearing." The act of imitating stammering affects
the kinaesthetic images more directly, but it probably
affects the auditory imagery also, when this happens
to be strong. It seems not unlikely that auditory
imagery is weak in persons that acquire stammer-
ing through voluntary imitation. If the auditory
imagery were weak, it would not easily counteract
the effect of a slight perversion of the motor
memory. On the other hand, it might be argued
that if the auditory imagery were strong, it
would itself be more easily distorted. However, the
auditory imagery is rectified by the acoustic impres-
sions that the stammerer receives when listening to the
speech of other persons. His kinaesthetic imagery is
probably not corrected by these impressions.

It seems improbable that the mere act of imitating
stammering or stuttering should effect organic changes
in the brain-cells or fibres. The act of imitating

272 THE PSYCHOLOGY OF STAMMERING

stuttering might perhaps induce an exalted excita-
bility of the motor centres concerned in speech, and
there would then result a species of reflex stuttering.
It seems unlikely, however, that such a condition
occurs. The cause is more probably psychological.
But if even a temporary disturbance in the motor
centres were to exist, a perversion of the speech-im-
agery might ensue, and the impediment would then
be established.

Acquired stammering is, in most cases, soon con-
firmed by the development of fear and by mental
confusion resulting from the attempt to avoid difficult
words by the use of synonyms. These complicating
causes will be discussed in the two succeeding chapters.

Stammering is often acquired by children as the
result of association with other stammerers. What-
ever a child learns, he learns chiefly through imitation.
If those around him speak English, he speaks English.
If those around him use provincialisms, he uses
provincialisms. If those around him stammer, he
learns to stammer also. To him stammering may,
indeed, appear as a normal mode of speech — or it
might if he were able to reflect upon the matter.
What really happens is that he hears stammering, and
acquires distorted images of speech by the same
process that would under other conditions inculcate
normal verbal imagery. With his imagery dis-
torted, he must stammer as a consequence. When the

STAMMERING 273

child is associated with both stammerers and normal
speakers, he may acquire either natural or abnormal
speech. The matter will be determined entirely by
the nature of the speech of the persons from whom
he acquires the greater part of his instruction or
whom he imitates most frequently.

A child's mental imagery may become distorted
through association, even after he has acquired a
thoroughly normal utterance. If he comes into fre-
quent contact with stammerers at the age of six
or seven, his speech may become affected through in-
voluntary imitation. It is the auditory imagery that
is first affected ; but the kinaesthetic imagery may be
indirectly affected by the fact that the auditor takes
the words of the speaker, as Bain expresses it, into a
"vocal embrace." Ultimately both forms of imagery
must become affected, for the child feels his stam-
mering, even if this is originally induced by auditory
cues.1

It follows from the foregoing discussion that one's
verbal imagery might become distorted as the result
of a speech-disturbance due to purely temporary

1 Children have, of course, a decided propensity for imitating most
of the abnormal conditions that they observe; and they imitate
chorea, epilepsy, etc., just as readily as they imitate stammering. It
is related of Boerhaave that he once had to contend with an epidemic
of epilepsy at the Haarlem Orphan Asylum. He had several pairs of
red-hot tongs prepared in a huge brazier in one of the halls. He then
called the children together, and told them that he had given orders

274 THE PSYCHOLOGY OF STAMMERING

causes. After the disappearance of the inducing
cause, the impediment might persist as a consequence
of the distorted imagery. Stammering would then be
due, as it were, to self-imitation, and would continue
in spite of the absence of auditory amnesia. When
stammering of this kind exists, it probably manifests
itself impartially under all conditions. When there
is variability in the impediment, the disturbance is
complicated by other causes.

There remains now only one of the peculiarities of
stammering to be accounted for — the fact that the
disturbance usually makes its appearance during child-
hood. The primary reason for this fact is that the
child is more susceptible during his early years to those
causes that induce stammering. One of the most
prolific causes of stammering is fright. The child is
exposed to this cause on account of his inexperience.
Objects and occasions that induce fright in early years
have no such effect in later life, for the reason that
they are better understood.

Infectious fevers are also among the principal cause

for all of them that had epileptic fits in future to be promptly branded.
This somewhat questionable procedure apparently terminated the
epidemic (see Mosso, " Die Furcht," p. 233). Similar epidemics of
imitative stammering seem to occur at times in different communities.
To explain this involuntary imitation one must, of course, explain the
morbid imitative propensity as well as the mental process by which
the imitation proceeds.

STAMMERING 275

of stammering. These fevers generally occur during
the earlier years of one's life. Measles, scarlet fever,
chicken pox, etc., are usually the illnesses of childhood.
It would be safe to say that, with the average person,
a majority of the infectious fevers that he suffers
during lifetime occur before he is ten years of age.

During the early years of life, when the child is
susceptible to the inducing causes of stammering, the
mental imagery is in an unstable condition, and is
probably for this reason more liable to derangement.
Loss of one of the senses during early childhood re-
sults in total obliteration of the corresponding mental
imagery. This fact shows that the mental images are
only superficially enregistered in the cells. It seems,
therefore, reasonable to suppose that a relatively slight
disturbance may affect the mental imagery. More-
over, if the child inherits weak auditory imagery, he
is already predisposed to stammering, and naturally
succumbs to the first inducing cause.

The infrequent appearance of stammering in adult
life is accounted for by the more secure establishment
of the kinaesthetic verbal imagery. A minor form
of auditory amnesia is less likely to affect oral speech
after a person has had twenty or thirty years of
practice in the correct use of the speech-organs. This
latter circumstance affords an explanation for the fact
that functional aphasia occurs more frequently in
children during fevers than it does in adults. Greater

276 THE PSYCHOLOGY OF STAMMERING

clearness of the auditory imagery in girls may account
for the fact that these functional disturbances are less
common among them than among boys.1 However,
stammering can develop at any time in life if the audi-
tory amnesia is sufficiently severe and the patient is
an audito-moteur. All that is necessary is that there
shall be temporary auditory amnesia without kinses-
thetic verbal amnesia. The patient then knows
what word he wishes to use, and he knows what the
word means. He has a clear kinaesthetic image
that permits him to commence its articulation,
but no auditory image to enable him to continue.
Whenever this condition occurs, stammering results.
It is by no means necessary that the inception of
stammering be confined to the early years of life;
in some cases the speech-disturbance does not begin
till after the fortieth year. The reasons, however,
have been stated why the impediment generally makes
its appearance during childhood.

A remark may be made at this point concerning the
acumen of the average stammerer. It is sometimes
thought by ignorant persons that the stammerer
is not particularly robust in intelligence ; but the belief
is without foundation. The stammerer is not usually
mentally deficient, though in many respects he may
appear eccentric. His eccentricity is due solely to his
1 See Wyllie, "Disorders of Speech," p. 391.

STAMMERING 277

stammering. He frequently uses odd phrases and
circumlocutions in order to avoid difficult words,
and in this way may appear somewhat outri to
persons that do not understand his motives. The
stammerer sometimes seems to be actuated by vacil-
lating purposes, and in this circumstance may appear
erratic. In such cases he has a dual purpose in view ;
and one purpose — which is not manifest to the casual
observer — is to avoid stammering at any cost. He
appears erratic merely because his purposes are not
fully understood.

The fact that the stammerer is subject to temporary
auditory amnesia under particular conditions does
not in the least militate against his intelligence. Even
if the auditory amnesia were plenary and permanent,
the mental faculties would probably remain un-
impaired. The mere absence of a particular form of
mental imagery does not affect the general intelligence.
If evidence were wanting on this point one might
cite the case of Hellen Keller. This noted deaf-
blind subject is possessed of exceptional intelligence
despite the fact that her mind is almost exclusively
kinaesthetic and tactual.

So far as intelligence is concerned, stammerers are
normal persons. They probably vary between the
two extremes just as do persons of normal speech.
Frequently stammering is one of the degenerative
marks of genius. In his " Man of Genius, " Lombroso

278 THE PSYCHOLOGY OF STAMMERING

cites the following men as stammerers : Aristotle,
JEsop, Demosthenes, Alcibiades, Cato of Utica, Virgil,
Manzoni, Erasmus, Malherbe, Charles Lamb, Turenne,
Erasmus Darwin, Charles Darwin, Moses Mendels-
sohn, the philosopher; Charles V, Romiti, Cardan,
and Tartaglia.

Chervin 1 cites Boissy d'Anglas, Camille Desmoulins,
and the artist David as stammerers. Charles Kingsley
and Martin Tupper were also stammerers. With so
many of the world's greatest geniuses among stam-
merers, one might almost regard stammering as an
accomplishment rather than a defect.

1 " B£gaiement et autres maladies fonctionnelles de la parole,"
3d ed., p. 32.

CHAPTER VIII

MENTAL CONFUSION IN STAMMERING

THE auditory amnesia that we have discussed in
the preceding chapter is the proximate cause of stam-
mering. There are, however, two collateral causes —
mental confusion and fear — that complicate the dis-
order. Mental confusion will be the subject of the
present chapter.

When the stammerer finds himself suddenly checked
in the utterance of a word, he frequently attempts to
elude the word by the use of synonyms. This ruse
may succeed if an easy synonym is at once forth-
coming; but frequently the synonym that suggests
itself is no easier than the word that has been re-
jected. In this case there may ensue a veritable
avalanche of thought to which no human speech-
organs could give expression. The stammerer is
then at a standstill till the original word or a synonym
is finally expressed in clear-cut mental imagery.

To take a specific example : The stammerer at-
tempts to say the word Thursday, but owing to audi-
tory amnesia he finds himself unable to pronounce it.
Immediately he decides to substitute another expres-

279

280 THE PSYCHOLOGY OF STAMMERING

sion for the refractory word, and while articulation
remains in abeyance, numberless periphrases flash
through his mind, — "The day after to-morrow,"
" In a couple of days," " In a few days," " In two days,"
"Perhaps Wednesday or the next day." If none of
these expressions are satisfactory, the stammerer
may reconstruct the whole sentence — and even pre-
ceding sentences — in order to circumvent the difficulty,
or he may come back to his original word and struggle
with it till he finally utters it. During this bewilder-
ment the stammerer frequently goes through all
sorts of contortions in an attempt to express verbal
thoughts that are chaotic to the last degree. The
effort may continue where it started with the original
word, the tongue pressing vigorously against the
teeth; or each expression as it is thought — far too
rapidly for utterance — may give rise to some rudi-
mentary change in the disposition of the articulative
organs.

It is manifest that no word could possibly be pro-
nounced under mental conditions such as those
described. The word Thursday cannot be articu-
lated because it is no longer thought. The cir-
cumlocutions that suggest themselves flash through
the mind so rapidly that no speech-organs could
ever express them. The stammerer thinks a whole
language in a moment in much the same way as a
drowning man recalls half a lifetime in the last few

MENTAL CONFUSION IN STAMMERING 281

seconds of consciousness. The verbal image is
paramount in determining the nature of the words
expressed ; hence if no clear-cut verbal image is in the
mind, no word can be orally produced. It is no more
possible for the speech-organs to produce a word that
is not clearly expressed in verbal imagery than it is
possible for a gramophone to produce words that are
not present on the record. The gramophone repro-
duces words as they are spoken into it: the speech-
organs reproduce words as they are dictated by the
verbal imagery. The verbal imagery is absolute.

In cases similar to the one just cited, the multiple
thought (as we may call the profuse and entangled im-
agery just described) is a collateral cause of stammer-
ing, being itself induced by the amnesia. But in many
instances the multiple thought is the sole cause of the
immediate disturbance. The stammerer is speaking
with apparent ease and fluency, when suddenly there
looms up before him a word that has formerly caused dif-
ficulty and that he therefore endeavors to avoid. There
then occurs the same frantic search for synonyms, the
same avalanche of thought, and the same stoppage in
speech. But the disturbance is not induced by audi-
tory amnesia: it is occasioned by the fact that the
speech-organs cannot express the chaos of the mind.

Here we may take another concrete example :
The stammerer wishes to say, "How do you like that
picture ?" As he utters the word you or like he fore-

282 THE PSYCHOLOGY OF STAMMERING

sees disaster at the end of the sentence. Articulate
speech is then and there at an end. The word that
is being uttered becomes abortive, its mental image
being extruded from the mind by the search for syn-
onyms. Innumerable words — sketch, painting, land-
scape, masterpiece, canvas, production, performance,
and a dozen others — flash through the mind. If the
stammerer finds one that he can articulate, he is able
to proceed. He then frequently endeavors to hide
his dilemma by recasting the sentence. The question
then becomes "What do you think of that painting ?"
"Does that landscape suit your taste?" "Is that
canvas to your liking?" etc. If the stammerer is
little embarrassed, he may give no evidence of his
predicament. He pauses quietly, selects the desired
word, and continues when he has the thought satis-
factorily framed.

There is often a tangle of visual images participating
in the multiple thought. These may be visual images
of words, or visual images of objects. The stammerer
is in a shop, let us say, where he has to make a number
of purchases. He attempts to ask for a particular
article, but stammers hopelessly when he endeavors
to name it. Thereupon he decides to ask for one of
the other articles first, and to essay the refractory word
at a more propitious moment. The chances are that
the utmost mental confusion will result. Visual
images of the different objects and mental images of

MENTAL CONFUSION IN STAMMERING 283

words rush through the mind in perfect chaos. Dur-
ing this bewilderment, stammering must of course
continue; and it is probable that the speaker will
not be understood when he at last gives utterance to
some half-smothered expression.

We may consider another case in which visual
images are present to add to the bewilderment.
The stammerer is asked the way to a certain street
or building, and there are different routes that he
may describe to the inquirer. The stammerer starts
to give directions for a particular route, but finds
after a few sentences that he is hopelessly stranded
on the name of a street he wishes to mention. It is
not essential, however, that this particular street be
referred to, for an alternative route may be described.
The stammerer then vacillates between the decision
to proceed with the original directions and the decision
to describe an alternative route ; and there occurs in
his mind a tumult of thought in which verbal images
and visual images of streets and buildings are tumbled
together in hopeless confusion. Meanwhile the phys-
ical stammering probably finds expression in a motor
circle. The stammering terminates only when clear
verbal images arise to mediate the expression of clear
oral speech.

Frequently, during stammering, verbal thought is
inhibited rather than confounded. The mind is then
a blank, or the entire field of consciousness is engaged

284 THE PSYCHOLOGY OF STAMMERING

by a visual sensation or a visual image. The stam-
merer is asked the name of a particular book, let us
suppose, but is afraid of certain words that occur
in the title. He makes no attempt to reply, but
stands mentally transfixed, gazing at any object that
happens to be before him. Or it may happen that a
visual image gets to the focus of attention, and the
stammerer then stares helplessly at a mental picture
of the book or a visual image of its title. For a
minute or more he makes no attempt to answer the
question, but deliberately suppresses the auditory-
motor images of the requisite words. Usually the
mind is more prolific, and the stammerer is able to
resort to synonyms. It might seem that synonyms
would be unavailing in the present case ; but this is
not necessarily true. Often the stammerer would not
hesitate to pervert the title in quoting it (believing
that any irregularities will be attributed to error), or
to improvise a title for himself, or to plead entire
ignorance in the matter.

In many cases of stammering the impediment is
in large part due to confusion or inhibition of thought.
It then frequently happens that the impediment dis-
appears almost entirely in reading and reciting.
Under these circumstances the stammerer is not
obliged to select his words; consequently mental con-
fusion is eliminated. Most stammerers speak with
less difficulty when alone. The greater fluency is in

MENTAL CONFUSION IN STAMMERING 285

this case largely attributable to the fact that the
speaker does not try to avoid stammering, and conse-
quently does not become bewildered in his effort
to avoid difficult words.

Another possible explanation for the stammerer's
occasional fluency in reading has already been sug-
gested. The visual impressions may arouse tHe re-
fractory auditory images by association, or they may
directly arouse the kinaesthetic images. It will be
remembered that the ability to read aloud is not at all
uncommon among aphasic patients, — even when they
are quite unable to speak spontaneously. In such
cases the explanation is the summation of stimuli or
the arousal of refractory images by sensations with
which they are associated. This same explanation
would apply to the case of the stammerer. It does
not, however, account for the stammerer's occasional
ability to recite, so we must conclude that the elimina-
tion of bewilderment is also an important factor.

With a great many stammerers there is no mitiga-
tion of the impediment in reading and reciting. In
some cases, indeed, the disturbance may be aggra-
vated. The exacerbation is produced by the stam-
merer's fear and confusion. The increased fear is
due to the fact that the stammerer finds himself
the centre of attention, and to the fact that he an-
ticipates difficulty with particular words. The
confusion is occasioned by the stammerer's exploring

286 THE PSYCHOLOGY OF STAMMERING

in advance in search of difficulty. His attention
is not concentrated upon the words he is actually
pronouncing : it is divided between these words
and those that he knows are to follow. The
stammerer, moreover, will often substitute words
even in reading, and will interpolate phrases of his
own. "Any port in a storm" seems to be the motto.
This attempt to paraphrase difficult passages leads,
of course, to entangled thought that cannot be ex-
pressed.

The enhancement or mitigation of the impediment
in reading and reciting is determined chiefly by the
stammerer's mental attitude. When attention is
concentrated upon the words that are being spoken,
stammering is limited to the amnesic form. (The
amnesia may, of course, be augmented to some extent
by fear.) When the stammerer endeavors to struggle
against the inevitable by paraphrasing passages and
meeting trouble in the distance, the impediment is
indirectly induced by mental confusion, as well as
being directly induced by auditory amnesia.

A too rapid production of verbal thought has been
considered by many investigators to be the proximate
cause of stammering. But the stoppage of speech
that they have considered is usually due to mental
chaos rather than to a rapid production of clearly
thought verbal images. These two conditions, mental
chaos and a slightly too rapid production of verbal

MENTAL CONFUSION IN STAMMERING 287

images, must be differentiated. When the verbal
images succeed one another too rapidly for utterance,
cluttering, and not a stoppage of speech, results.
Wyllie refers to the former defect in the following
words :

"When the words crowd upon each other so much as to
interfere with their distinct articulation, the condition has some-
times been called ' Cluttering. '" l

Wyllie then quotes Dr. Clouston's description of
a case of this kind :

"Although 'articulation is normal when slowly performed,
the moment ordinary speech begins, the mental coordination
is lost, and we have a torrent of half-articulated words, follow-
ing each other like peas running out of a spout.' " 2

This condition does not often occur with persons
of normal intelligence. It is evident that the will
to speak is present, but that the speech-mechanism
is unequal to the task imposed upon it. When
stammering occurs as the result of multiple thought,
it is not willed that the rapidly thought verbal images
shall be enunciated. The stammerer's purpose is
primarily to select a word to which he believes he can
give utterance; and the mental synonyms that
occur in thought are as a rule not even incipiently
articulated. The images pass so rapidly through
the mind that they could not be expressed even if

1 "Disorders of Speech," p. 139. * Loc. cit., p. 140.

288 THE PSYCHOLOGY OF STAMMERING

they occurred in pure kinaesthetic form. Quite fre-
quently these verbal images appear in visual form,
and hence have no direct effect upon the speech-organs.
Multiple thought is mental chaos, and it is not the
same mental condition that gives rise to cluttering.

A condition of speechlessness frequently occurs in
normal speakers as the result of mental confusion.
It is often the concomitant of emotional excitement ;
and the person is speechless with fear, anger, or dis-
may. Speechlessness occurs either because there is a
failure of verbal thought or because the verbal thought
is too tumultuous and chaotic to find articulate ex-
pression. This emotional condition frequently gives
rise to temporary "stammering" in children. The
child attempts to describe something that has deeply
impressed him. He gasps and gesticulates, but says
nothing. This inhibition is produced by a tangle of
thought that probably subsists for the most part in
visual terms. The condition is not induced by amnesia,
and the child is able to speak with fluency if he is
compelled to calm himself before making the attempt.

The tendency to think in visual terms is not in
itself a cause of stammering. There are numberless
persons that think almost exclusively in visual images,
but they are not necessarily troubled with disorders
of speech. The practice of thinking in visual terms
may be a serious bar to fluency in speech, for the
habitual visualizer does not always readily recall the

MENTAL CONFUSION IN STAMMERING 289

words necessary for the expression of thought. This
paucity of verbal images gives rise, however, merely
to hesitancy in speech and not to genuine stammering.

It is well for the stammerer to bear in mind that
any articulate sounds produced by the speech-organs
are, in general, reproductions of the verbal imagery.1
The articulative mechanism does not reproduce all
that is passing in the mind, but whatever is produced
is mentally initiated. When the stammerer prolongs
a consonant in speech, he prolongs it also in thought.
When he repeats a word, syllable, or consonant in
speech, he repeats it in thought. The prolongation
of the consonant is due to the amnesia. But the
repetition — especially of syllables and words — is
usually purely voluntary. The stammerer makes
the repetition in order to overcome the resistance, as
it were, by the sheer momentum of the articulation.
But the speech reflects the thought, and the stam-
merer will not always find that this mental repetition
affords the best method of procedure.

It is possible that even cluttering may in some cases
represent the verbal imagery, and that the cluttering
is subjective as well as objective. A species of clutter-
ing sometimes occurs with the stammerer even when he
knows clearly what words he wishes to utter. Under
the influence of fear the words are produced (or, more

lThis remark does not apply to some extraneous sounds that
may accompany physical stammering.

290 THE PSYCHOLOGY OF STAMMERING

accurately, smothered) so rapidly that it seems as
though they must be initiated by a sort of generic
verbal concept instead of by a series of verbal images
dearly expressed in the mind. The stammerer
gasps out the first few words of the sentence and
is then hopelessly checked by amnesia or by an in-
ability to decide between repeating the sentence and
continuing from the point he has already reached.
No general statement can be made as to whether this
cluttering is mental or physical. In some cases the
speech may exactly represent the verbal imagery;
in others the verbal imagery may be clear, though it
cannot be clearly expressed because it is too rapidly
produced and because fear paralyzes the musculature.

CHAPTER IX

FEAR AND AUTO-SUGGESTION

FEAR is perhaps the most important of the mediate
causes of stammering. The stammerer's fear is
somewhat similar to stage-fright. It takes the form
of an all-consuming dread that effectively deprives
the speaker of muscular control. This fear is difficult
for the non-stammerer to understand. It is not
merely the fear of incurring ridicule, or the fear of
making oneself ridiculous; it is rather the fear of
"travailing with unborn thoughts." It is one of the
subjective aspects of stammering that only the stam-
merer himself can comprehend.

Schulthess has compared the stammerer's fear to
hydrophobia, and he named the condition "Phono-
phobia," or "Lalophobia." Wyneken, having regard
to the stammerer's fear of particular words, de-
nominated him a "speech-doubter" (Sprachzweifler).1
He believed the stammering to be due largely to a
wavering of the will during speech; this vacillation
being caused in its turn by the stammerer's lack of
confidence in his own speech-organs. Strictly speak-

1 "Ueber das Stottern und dessen Heilung," p. 20.
291

292 THE PSYCHOLOGY OF STAMMERING

ing, this latter condition is not fear; it is inhibition
of the will due to auto-suggestion. Both fear and
auto-suggestion are potent factors in the indirect
production of stammering. Denhardt, in his " Stottern
eine Psychose," maintains the position that these
factors are the sole causes of the defect. His argu-
ments are interesting and well worth following.

Denhardt attempts first of all to refute the current
theory that stammering is due to a failure of voice.
He declares that he has occasionally seen stammerers
that were unable to articulate isolated consonants
entirely unattached to vocal sound.1 The phenome-
non that Denhardt describes would refute the "failure
of the voice" theory, but it is itself readily explained
by the theory adduced in this monograph. When a
person articulates the consonant b (for instance) in
the physiological alphabet, he produces the vowel
en souffle, or thinks it in auditory imagery and sup-
presses its oral production. If the auditory image
fails, the speaker may appear to stammer even on a
simple articulatory movement.

The auditory image attached to the physiological
consonant is not necessarily an image of the vowel-
sound that is associated with the consonant in the
common alphabet. It may be an image of the short

1 That is, a consonant in the physiological alphabet, in which b,
for instance, is a mere explosive movement of the lips, and not the
word be, as we know it in the ordinary alphabet.

FEAR AND AUTO-SUGGESTION 293

u (ti) that generally follows an explosive physiological
consonant. The failure of this image would account
for the stammering. If one were to stammer on a
simple movement of the lips that is kinaesthetically
initiated, he would stammer at the end of words,
and would stammer in smoking, etc.

Denhardt then attempts to refute the "failure of
voice" theory by showing that stammering some-
times occurs when the speaker is making the transition
from the vowel to the consonant. He says : l

"On the other hand, there are not lacking stammerers that
experience difficulty in making the transition with the speech-
organs from the position taken by the vowel to that required
for the consonant; consequently they repeat the vowel once
or twice in the form of a short ' af terstroke ' before they are able
to seize upon the consonant that completes the syllable. As
a result one hears something like Ka-ap and La-and, instead of
Kap and Land."

It is somewhat strange that Denhardt should
interpret these symptoms as betokening difficulty in
making the transition from the vowel to the consonant.
The symptoms are unquestionably due to respiratory
disturbances, one of the chief features of physical
stammering. The break in the vowel is due to a
sudden inhibition of the expiratory current: the
weakening of the air-column permits the glottis to
dose, consequently there is a brief interruption in

1 "Das Stottern eine Psychose," p. 28.

294 THE PSYCHOLOGY OF STAMMERING

vocalization. The stoppage of the expiratory current
is due to a fluttering of the diaphragm, — one of the
natural concomitants of emotion.

There is another possible explanation for this
"catch" in the vowel that Denhardt describes. The
stammerer may vocalize from purely kinaesthetic cues,
but so long as he cannot recall the auditory image he is
unable to produce the vowel-color. It will be remem-
bered that this imperfect enunciation of the vowel
has been described by Hunt and other writers. (See
pp. 190-192.) It often takes the form of an inhibition
of the second element of a diphthong. As a rule, the
difficulty is directly due to defects of the auditory
imagery; but it is never due to the fact that the
stammerer experiences difficulty in articulating the
final consonant.

These arguments of Denhardt are mentioned chiefly
because they are based upon facts that seem, if only
superficially examined, to be at variance with the theory
advanced in this monograph. They are the only heter-
odox facts that have been encountered, and it has
seemed advisable to lose no time in disposing of them.

Denhardt refutes, more or less successfully, the
current theory that stammering is due to a failure of
voice. He then defends the theory that stammering
is induced solely by fear and auto-suggestion :

" If one asks the stammerer why he is unable to speak fluently,
he will in most cases receive the reply, ' It is because of fear.' . . .

FEAR AND AUTO-SUGGESTION 295

If one goes a step further and endeavors to assure himself of
the nature of this fear and its foundation, he will regularly
find that it is based upon the stammerer's belief that he is
unable to speak." 1

"It is quite immaterial for the influence of the disturbing
belief whether or not it has any foundation in fact. But the
belief has with the stammerer no basis in reality, for under
certain circumstances he is able to speak with consummate
ease." *

"We have to deal with a delusion that has driven its roots
so deeply into the consciousness of the stammerer that even if
it should leave him — as it may for days, weeks, or months
together — it invariably returns; frequently, too, with in-
creased intensity." *

One of Denhardt's chief arguments is the existence
of analogous phobias. He cites the case of a flute-
player that experienced the same difficulty in playing
as he did in speaking:

"When he had to play a solo with orchestral accompani-
ment, he felt himself incapable of beginning at the proper in-
stant. For hours before, he was haunted by fear of the dreaded
moment ; and the fear increased as the time approached. In
his room he could perform without hesitation ; but in the con-
cert hall, a few hours later, this had become an impossibility." 4

"I have seen stammering in piano-playing on several
occasions," remarks the same writer. He then re-
counts the experience of a young lady :

1 Loc. tit., p. 144. * Lac. tit., p. 144.

1 Loc. cit., p. 145. * Loc. cit., p. 178.

296 THE PSYCHOLOGY OF STAMMERING

"The eye would explore hastily in advance of the hands,
and would discover difficulties that at once induced fear of
failure. The nearer she approached them, the greater became
her fear of the supposed obstacles ; and at the critical moment
the disturbing influence of the fear effectually prevented the
proper execution of the necessary movements." *

Denhardt then gives an account of a subject that
was unable to write if some one were watching over
his shoulder :

"Whenever an R had to be followed by a vowel, there arose
in his mind the thought that he could not freely execute the
necessary writing-movements. Like the stammerer, he per-
formed all kinds of superfluous and purposeless movements.
Finally he accomplished his task by separating the vowel from
the initial consonant by a long dash (R — abe). When he
knew himself to be unobserved he experienced no difficulty
with any combination, not excluding Ra, Ro, etc." 2

The author then cites two cases in which difficulty
in swallowing was due to delusional belief, — to a
loss of confidence in the ability of the physical organs
to perform their normal functions. He says of one
subject :

"Upon my own initiative I brought him to the belief that
he had incurred the difficulty as the result of excessive cigar-
ette smoking. Upon his relinquishing the cigarettes, the
trouble disappeared. ' Now comes the stammering. Although
I have not smoked a cigarette since the improvement in my
condition, I have only to recall my former troubles in order to

1 Loc. cit., pp. 178-179. * Loc. tit., p. 179.

FEAR AND AUTO-SUGGESTION 297

induce difficulties in swallowing. I then incur a relapse for a
day.'"1

"The next case is of a little different nature. A gentleman
was accustomed for several years to taking all liquids from a
spoon, believing himself to be unable to drink. In drinking
from the spoon, however, he executed all the movements of
deglutition in a perfectly normal manner — proof that he had
lost nothing of this faculty with which he was merely afraid
to intrust himself. The use of the spoon was of value only in
so far as it exerted a favorable influence upon his imagination.
The effects of the delusion were counteracted by the confident
belief that the use of the spoon would remove difficulties that
might otherwise appear. One day, after a long and trying
march, and while tormented by thirst, he rapidly drank a glass
of beer without reflecting. As the result of this incident he re-
gained his lost confidence in the organs of deglutition ; and this
confidence did not thereafter desert him." 2

Denhardt concludes the recital with an account of a
man that had lost confidence in his ability to use his
hands in the presence of other people. While using
a soup-spoon, for instance, his hands would tremble
so severely that he became practically powerless.
He was able to master this weakness only by beginning
the meal with a powerful stimulant.

These morbid fears or obsessions are common
enough in pathology, and cases similar to the fore-
going might be cited indefinitely. The abnormal
fears are known as phobias. Many of them have
been endowed with a special name. Erythrophobia is

1 Loc. cit., p. 180. * Loc. cit., p. z8x.

298 THE PSYCHOLOGY OF STAMMERING

the morbid fear of blushing; klithrophobia, or klaus-
trophobia, is the fear that seizes one when alone in a
room; agoraphobia is the fear of crossing open
thoroughfares. When the agoraphobic patient is
compelled to cross an open square or traverse a wide
thoroughfare or bridge, —

"There ensues, according to Westphal's characteristic
description, an inordinate fear — a veritable death-terror —
accompanied by general trembling, an oppression of the chest,
palpitation of the heart, and sensations of chills or of a warm
wave mounting to the head. One breaks into a perspiration,
and stands as though helplessly paralyzed. There is weakness
of the limbs, and often sparks dance before the eyes. There is
humming in the ears ; there is nausea and complete confusion." l

St. Phar refers to these morbid fears in the following
words : 2

" Pathological fear makes its appearance in the most diverse
forms, and not merely as agoraphobia. One person cannot
travel by train, another cannot ride in an electric car, or in
any vehicle at all, without experiencing these conditions of
fear. One patient is attacked by this abnormal dread during
thunder-storms; another when he finds himself in the midst
of a crowd, or when he is in a theatre, a church, or in a room
above the ground floor, or in a tunnel. Others experience
terror when the weather is a little more than ordinarily warm or
cold. Abnormal fears are particularly likely to appear under
those circumstances in which normal persons experience nor-
mal fear, as in accidents, earthquakes, fire, flood, and danger of
any kind that induces emotional disturbances and threatens

1 Eulenburg, Die Woche, March 17, 1906. 2 "Angst," pp. 4-5.

FEAR AND AUTO-SUGGESTION 299

life and property. In short, fear is extremely multifarious.
It can appear in connection with any conceivable circumstance ;
and it reappears usually under those circumstances that were
responsible for its origin. It varies with the same patient,
assuming sometimes a more malignant and sometimes a milder
form."

In these phobias two conditions must be differen-
tiated. There is the simple fear, as such; that is,
the mere emotional disturbance : and there is the emo-
tion accompanied by an obsession or delusional belief.
In the fear of thunder-storms, only the emotional dis-
turbance is present. In agoraphobia there is abnormal
fear and also the belief in one's inability to cross the
thoroughfare. When both the fear and the delusion
are present, they of course react upon each other.

The phobias are either due to some unfortunate
experience accompanied by intense emotion, or they
are simple atavisms. In the latter case they are
reverberations of racial experience ; i.e. they are in-
stinctive fears. In either case the emotion is aroused
by association. When the fear is acquired, the associa-
tion is due to the experience of the individual. When
the fear is instinctive, the association is due to racial
experience. This matter will be discussed subse-
quently at greater length.

After this slight amplification we return to the
subject of stammering as caused by phobia and delu-
sional belief. Denhardt cites the morbid fears already
mentioned ; then continues :

300 THE PSYCHOLOGY OF STAMMERING

"Supported by the analogies mentioned, we can safely state
that no objection need be feared to the theory already pro-
mulgated, — that stammering is a psychosis having its origin
in some more or less casual incident in the history of the patient.
This psychosis is based upon a delusion, an absolutely un-
founded belief that there exists an impediment to the free use
of speech. This delusion wreaks havoc with the different in-
nervations requisite for oral speech. Neither the expression
'fear' (Schranck) nor the term 'doubt' (Wyneken) is applicable
to this delusion, for when the delusion arises there is not doubt,
but subjective certainty ; and this certainty is not always ac-
companied by such feelings of malaise (Unlustgefuhle) as
would justify one in speaking of 'lalophobia' or 'speech-fear.'
These feelings of malaise are secondary, being induced by the
delusion, — which naturally enough gives rise to painful ex-
periences. One might regard stammering as one of the mani-
fold forms of hypochondria if the symptoms of the latter affection
were delusions concerning bodily disabilities, rather than 'fear
and anxiety for the body itself.' " 1

The chief flaw in Denhardt's theory is that it does
not account for the inception of the speech-disturb-
ance. Denhardt imagines that stammering begins
by some sort of accident — an accidental stumbling
in speech — and that introspection then confirms the
defect. (This same introspection and fear is made
to account for stammering when it is induced by
imitation and association.) The initial trouble
having arisen, the development of the malady
is easily explained:

1 Loc. cit., pp. 181-182.

FEAR AND AUTO-SUGGESTION 301

" Should the revived memory-picture possess sufficient clear-
ness and intensity to awaken feelings of anxiety and fear, and
should its fatal influence not be neutralized by reason or by an
unwavering faith hi one's own faculties, then there steps in for
a second tune bewilderment and delay to wreak havoc with
the movements that should give oral expression to thought.
The incident will be repeated, and with every repetition the dis-
turbing influences find an easier victory. The anxiety rising
from the recollection has shown itself to be well founded. Any
dubiety as to its foundation, which might at first have appeared,
is silenced by the seemingly incontrovertible evidence of fact.
Forthwith there disappears anxiety — care lest there should
recur those unhappy disturbances with which the malady be-
gan — and in its stead there prevails the subjective certainty
that the stammerer no longer has unimpeded use of speech.
Thus there is established the delusional belief that any attempt
to speak is frustrated by an actual impediment; though this
impediment has in truth no existence outside the imagination
of the now fully developed stammerer. This belief, with the
concomitant feelings of malaise (at tunes weaker and at times
stronger) is thenceforth the in variable cause of stammering." l

The delusional belief, according to the author,
assumes all kinds of illogical forms :

"For instance, some believe that they can speak better
during warm than during cold weather ; while others hold the
opposite view. In a way, both are right, for it cannot be
denied that whenever the conviction of this relation has become
seated in the mind of the stammerer, the circumstances will to
an extent accommodate themselves to the belief. Whoever
looks for the mitigation of his trouble in warmer weather will,
with the advent of such weather, in reality feel freer and more

1 Loc. cit., p. 147.

302 THE PSYCHOLOGY OF STAMMERING

resolute, and will consequently stammer less. This result is
not to be attributed to the weather as such, but solely to the
stammerer's belief that the weather confers upon him a power
that he did not formerly possess." *

According to our author, a superstition prevails
that the intensity of the stammerer's impediment is
in some way correlated with the different phases of
the moon. The waning moon is supposed to mitigate
the impediment, and the crescent moon to aggravate
it. This belief influences the stammering:

"He that firmly believes in this lunar influence will find his
observations to some extent in accord with his theory ; but that
the moon is not accountable for the correlation is clearly shown
by the following incident. During the course of a conversation
a stammerer once informed me of this relation between the
severity of speech-disorders and the phases of the moon. I at
once insisted that there must be some mistake: he had the
relations reversed. And in truth this same gentleman aston-
ished me soon after with the information that I was right, and
that the waning moon was accompanied by an enhancement of
the impediment. The belief aroused by my positive assertion
was sufficiently powerful to influence the mind of the stammerer
in the direction suggested, so that he was able to discover vari-
ations in his own impediment corresponding to the changing
phases of the moon." 2

Denhardt expresses a cogent truth in the theory
that stammering is due to fear and auto-suggestion.
The theory, however, expresses but a partial truth,
for fear and auto-suggestion merely aggravate the

1 Loc. cit., p. 86. * Loc. tit., p. 87.

FEAR AND AUTO-SUGGESTION 303

impediment — they do not cause it. They are them-
selves the effects of the disorder, and later they react
upon it as mediate causes. The immediate cause, as
we have seen, is usually transient auditory amnesia.
Denhardt himself regards the fear as an indirect rather
than a direct cause. The condition directly respon-
sible for the stammering he considers to be indecision,
or a wavering of will, this being caused in its turn by
the stammerer's lack of confidence in his own ability
to control the speech-organs. Denhardt says of this
vacillation of the will :

"An examination of the mental processes during stammering
shows that the disturbance takes the form of a struggle be-
tween two opposing forces, — the will, which endeavors to
translate the thought into spoken words, and the belief hi one's
inability to accomplish what is intended. The former impels
forward, and the latter backward : the will to speak initiates
a movement, but hi the same instant fear obstructs it. All
the characteristic phenomena of stammering emanate from this
conflict and from the visible efforts of the stammerer to pro-
cure the victory for the former at all costs. In the end, the will
to speak invariably prevails, and compels the enunciation of
the word that was at first checked or impeded by the stam-
merer's fatal belief in his own disability. Often this conquest
is made only after continued struggle and bewildering effort." l

This indecision and constant checking of the fiat
has been mentioned in the preceding chapter. It is
an immediate cause of stammering, but it is itself a

1 Loc. cit., pp. 176-177.

304 THE PSYCHOLOGY OF STAMMERING

secondary manifestation. There would be no waver-
ing of the will if an impediment to speech did not
first exist.

One of the chief faults in Denhardt's theory is that
it takes no account of the origin of speech-disturbances.
Denhardt carefully classifies the inducing causes of
stammering, giving them as mechanical causes (a fall
or a blow, for instance), mental shock, and illness;
but he does not show how these causes operate. After
the cause has appeared, the patient simply stammers.
However, Denhardt testifies to the aphasic nature of
stammering in the following paragraph r1

"One of my patients, when five or six years old, experienced
an unlucky fall on the head, which was accompanied by much
loss of blood. As a consequence he remained speechless for a
year. After this interval the speech returned, but it was dis-
torted by severe stammering, which had not left the patient
in his thirty-first year."

By the recital of such incidents and by his classifi-
cation of the inducing causes of stammering, Den-
hardt may fairly be said to compass the refutation of
his own theory.

As already stated, the theory supposes that the
impediment develops accidentally, and that it is con-
firmed by the subject's fear of its recurrence and by
his morbid introspection. The most cogent argument
against this developmental theory is that 87 per cent

1 Loc. cit., p. 104.

FEAR AND AUTO-SUGGESTION 305

of stammerers are, as children, already subject to
the impediment before they enter school. This
means that the impediment develops before the age
of five or six. At this age the child is not addicted to
reflective self-analysis. He is not an introspectionist ;
he is an animal leading a sensory-motor life. The
child does not reflect upon his own idiosyncrasies;
and at an early age his peculiarities of speech pass
unnoticed. Certainly the child is not capable of
morbid self-analysis such as induces phobia. The
child stammers because of auditory amnesia. The
morbid fear develops later in life.

Denhardt endeavors to anticipate these objections.
He asserts that the child's reflections are all the more
deleterious because they are unreasoning, and because
the fear is based upon ignorance. His chief difficulty,
though, is to show that the fear exists. In endeavor-
ing to establish the latter fact he unfortunately argues
by analogy.

"One gives a little child a sour apple [he says]. After the
child has bitten it and experienced the unpleasant taste, he
lets the apple fall or throws it away. Let one repeat the ex-
periment after some time, and he will see how the child turns
away with evident aversion and rejects the apple that is offered
him."1

Manifestly there is no parallel between these two
cases ; and any conclusion that may be derived from
1 Loc. dt., p. 153.

306 THE PSYCHOLOGY OF STAMMERING

the one has no application whatever to the other. In
the case of the apple we are dealing with a simple
association between a visual and a gustatory impres-
sion. In the case of stammering we are dealing with
an association between speech-hesitancy and an
emotion that has not yet been shown to exist. The
argument presupposes the existence in order to ar-
rive at the association. But even if the naive child
were to experience emotion and chagrin when
stammering, he would not be likely to develop lalo-
phobia through a process of morbid introspection.
Denhardt attributes undue precocity to the child.
If the child could develop stammering through morbid
anxiety after some accidental hesitancy in speech,
then there would exist a far greater number of stam-
merers; for every child falters at an early age when
acquiring command of language, and every child is
therefore a potential stammerer.

It is evident that Denhardt's theory fails conspicu-
ously in two respects : it does not account for the origin
of the stammering that is supposed to give rise to the
psychosis or phobia, and it does not account for the
fact that stammering develops in the entirely na'ive
period of life. The fear and auto-suggestion develop
at a later period, and they exist thereafter as mediate
causes. But the potency of these causes cannot be
easily overestimated. Denhardt has not emphasized
these secondary causes unduly. He is in error merely

FEAR AND AUTO-SUGGESTION 307

in supposing them to be the sole causes that exist.
His book shows an excellent attempt to throw aside
the futile theories of the elocutionists. It can safely
be said that the reader would be well repaid for a
perusal of this interesting work.

A great many writers hold to the theory expressed
by Denhardt, and several of them expressed the
theory before him. Wyneken states his opinion as
follows : l

"Were I to attempt an explanation of the case, I should say
that the will is more or less restrained — so far as its control
over the speech-muscles is concerned — and that this occurs
through fear. The stammerer is a speech-doubter. When
he attempts a difficult word, his will is partially lamed by doubt,
— which one can in a way regard as an independent will in-
imical to the true will. The muscles controlling respiration,
phonation, and articulation do not know — if I may so express
myself — which master to obey ; therefore they do not properly
perform their functions, and stammering naturally ensues.
It is just as though one were to attempt a leap, and find himself
seized with doubt at the very moment that he springs. He is
too late to prevent the leap, but does not jump with confidence,
and hence does not accomplish what he intended."

Werner says of fear : 2

"Why is it that the stutterer, when alone, has no trouble,
but the very moment some one enters his presence he becomes
helpless ? The answer comes with irresistible force, — be-
cause of fear."

'"Ueber das Stottern und dessen Heilung," pp. 20-21.
J Werner's Voice Magazine, Vol. XI, pp. 86-87.

308 THE PSYCHOLOGY OF STAMMERING

According to Frank:1

" Stammering is a fear-neurosis, which is caused in neurotic
children by fright during the earliest years of life."

Stekel says : 2

"One of the severest forms of pathological fear is found in
stammering, — the fear of speech. Originally it is the fear of
betraying some secret during speech. Later the fear becomes
transferred to the act of speaking itself."

Stekel introduces the inevitable "sexuelle Aetio-
logie" of the Freud school. At present his theories
of causality need scarcely be discussed.3 So far as
they relate to stammering they are sufficiently ridic-
ulous to carry their own refutation.

We shall now consider how these secondary causes,
fear and auto-suggestion, come to effect disturbances
in speech. We shall consider first the influence of
fear unattended by auto-suggestion, or belief in one's
own disabilities ; and then the effect of auto-suggestion
itself so far as it can be studied as an isolated factor.
Auto-suggestion, however, when it is a suggestion of
failure, is rarely unaccompanied by fear.

1"Die Psychanalyse," p. 15.

2"Nervose Angstzustande und ihre Behandlung," p. 231.
1 The theories of the psychoanalytic school are discussed at some
length in Vol. H, Chap. VIL

FEAR AND AUTO-SUGGESTION 309

THE DIRECT EFFECTS OF FEAR

Fear operates by paralyzing the musculature. It
inhibits even the grosser muscular movements. Many
persons cannot walk naturally upon a platform when
they know themselves to be the target for a battery
of eyes. Self-consciousness and fear deprive them
of muscular control, and there exists a condition
similar to agoraphobia. Westphal's description of
the patient suffering from agoraphobia (p. 298) is
merely the description of a person seized with extreme
fear. The person's helplessness is due to the fact
that he is mentally transfixed.

"People are frequently run over by carriages, cars, or trains
on account of the sudden great fright caused. The one idea
of danger reverberates in the mind like a sudden powerful clap
of thunder, confusing and stunning all other ideas ; the mind is
brought into a contracted cataleptic condition, and the field of
consciousness is narrowed down to that one idea, to a single
point." »

Animals are often thrown by fright into a cataleptic
condition. This may occur also with human beings.
The cataleptic condition is physical, but it is accom-
panied by a condition of "mental catalepsy," as Sidis
figuratively expresses it. Denhardt records the case
of a boy that would frequently faint when his stam-
mering became severe. The fainting may not have

1 Sidis, "The Psychology of Suggestion," p. 60.

310 THE PSYCHOLOGY OF STAMMERING

been wholly due to fear, but there can be no doubt
that it was due in large part to this cause.

Fear exerts its greatest influence upon the accessory
muscles. The articulative organs or fingers may be
rendered powerless when the larger muscles of the
body are practically unaffected. Fear causes one to
falter while playing the piano, and it interferes with
articulation in speech. The most fluent speakers
may be rendered impotent by stage-fright.

Fear induces cerebral congestion, and it is prob-
ably this condition that inhibits muscular control.
It will be remembered that Mosso's experiments
showed that there was a far greater flow of blood to
the brain during fear than during ordinary mental
activity:

"The brain-pulse became six or seven times greater than
before; the blood-vessels expanded, and the brain swelled
and beat with such vigor that my colleagues stared with aston-
ishment at the photogram of the tracings." l

Mosso relates an interesting incident apropos of
the afflux of blood to the brain, and the conse-
quent shrinkage of the body, during fear. A friend
informed him that upon the occasion of a sudden
fright a ring once dropped from his finger, — though
this ring ordinarily fitted so closely that considerable
effort was required to remove it. The incident shows
that fear must be accompanied by a prodigious flow

1 "Die Furcht," p. 73.

FEAR AND AUTO-SUGGESTION 311

of blood to the brain. During fright this afflux of
blood to the brain is often so great that it causes
death through rupture of the cerebral vessels.

Cerebral hyperaemia probably effects an obfuscation
of the mental imagery. This subjective condition
would account for the exacerbration of stammer-
ing during fear, and for speechlessness during stage-
fright. The direct cause is amnesia; the inducing
cause is fear. It is not surprising that fear should
induce transitory disabilities in speech, for fear is
one of the most prolific causes of permanent stam-
mering and is one of the causes of aphasia. The
more intense emotion induces permanent stammer-
ing or aphasia probably through rupture or exces-
sive distension of the finer cortical vessels. The
weaker emotion may induce temporary stammering
through cerebral hyperaemia that leaves no injury to
the brain.

Fear seems to be particularly inimical to the audi-
tory imagery, — or perhaps it is that the obscuration
of the auditory imagery manifests itself in more
direct form. Persons afflicted with stage-fright often
stutter and articulate without producing a word. It
seems as though they are able to recall the grosser
articulative movements requisite for the enunciation
of the words, but unable to recall the auditory images
necessary for their completion. In the stammerer,
the auditory imagery is more readily affected than

312 THE PSYCHOLOGY OF STAMMERING

imagery of other forms. The auditory images are,
as it were, more readily extinguishable. It is, of
course, this vulnerability of the acoustic imagery that
makes the person a stammerer.

Pure fear — even when it is not speech-fear — is
likely to produce mental chaos or bewilderment, and
thus to interfere with the execution of speech.
"Presence of mind" under conditions of emotional

Fio. 7.

•"Ordinary, quiet breathing; t, inspiration ; e, expiration"
(after David Greene).

excitement is a rather rare attribute. "Absence of
mind," or chaos of mind, is the more common con-
dition.

Fear may aggravate physical stammering by in-
ducing respiratory disturbances. The disturbances
usually take the form of a "fluttering" of the dia-
phragm. That the irregular action of the diaphragm
is due to emotion rather than to voluntary physical
stammering is shown by the fact that it is present
before the stammerer begins to speak. Often it com-
mences as soon as the stammerer is addressed. In-
trospection likewise discloses the fact that the abnor-
mal respiration is due to fear or excitement. The

FEAR AND AUTO-SUGGESTION 313

condition is often induced by the mere thought of
speaking, when no occasion for speech actually exists.
Many writers have investigated these respiratory
disturbances with the pneumograph. Liebmann says
on the matter : 1

Fio. 8. — " Irregular breathing caused by mental agitation while being
asked a question " (after David Greene).

"Gutzmann and I have studied the stammerer's abnormal
respiration by means of Marey's pneumograph. We ascertained
that the respiration of most patients becomes irregular just
before speech begins, and that all kinds of abnormal inspiratory
and expiratory movements occur during speech itself. During
normal, speech there occurs a short, deep inspiration, followed
by a long and gradual expiration." 2

Figures 7 and 8 show the respiratory curves obtained
by another investigator.8 The irregularities in the
second curve are caused by emotion. It is evident

1 "Vorlesungen tiber Sprachstorungen," i. Heft, p. 7.

1 See also Gutzmann und Liebmann, " Pneumographische Unter-
suchungen liber die Atmung der Stotternden." (Wien. Med. Bl., 1895.)

•David Greene, "The Preponderance of Male Stammerers over
Females." (New York Medical Journal, April 13, 1901.)

314 THE PSYCHOLOGY OF STAMMERING

that such abnormalities of respiration as those recorded
must inevitably reveal themselves in speech.

AUTO-SUGGESTION

We shall now study the direct effects of suggestion,
bearing in mind the fact that fear is usually present
as a complicating factor, and that pure auto-sugges-
tion rarely acts alone.

Stammering is sometimes induced by external
suggestion. It seems probable that fear is absent in
such cases. In the following words Sidis describes
the manner in which he induced stammering and
partial agraphia in one of his subjects : 1

"I then tried on Mr. W. another experiment. 'Pronounce
"Boston."' — 'Boston,' and he said it easily enough. 'And
now again.' I stretched out my hand and made it perfectly
rigid. ' P-p-p-p-oston ! ' he ejaculated with great difficulty.
'Again.' I made my hand stiff er, and pointed it almost directly
in his face. No sound. 'Don't look at me,' he said at last,
'and I shall be able to say it.'

"'Well, then/ I said, 'try the following sentence: "Peter
Piper picked a peck of pickled peppers." ' He began to say
it, but when he came to 'peck of I raised my hand and stiffened
it. ' P-p-pe-ec-k ' came from his lips ; he began to stammer and
could not continue.

"'Well, then,' I said, 'let me see if you are able to pro-
nounce your own name.' He pronounced it. 'Try again.'
I stiffened my hand and again the same result — he was unable
to pronounce his own name. . . .

1 "The Psychology of Suggestion," pp. 181 ff.

FEAR AND AUTO-SUGGESTION 315

'"Just try to write your name,' I said. He wrote it.
' Again.' He wrote it once more. I asked him to write slowly ;
meanwhile I raised my hand, stiffened it, kept it before his
very eyes. The results were now extremely interesting. His
hand became cataleptic; he could not manage it. In a loud
voice he began to give suggestions to himself. '/ am able to
write my name ; I can write my name ; I will and shall write
it ; yes, I can ; I can write my name ; ' etc. Each time as he
caught sight of my raised hand and listened to the torrent of
suggestions I poured forth his hand became slightly cataleptic
and the letters became broken, but each time he repeated his
suggestions the hand went on writing. . . . [Finally] my sug-
gestions were completely disregarded."

Stammering and agraphia were produced in this case
by the inhibition of muscular control. The sight of the
stiffened hand aroused in the subject mental feelings of
stiffness in his own muscles, and these kinaesthetic im-
ages were expressed in muscular contraction. There
probably resulted also an inhibition of the fiat, due to
the subject's belief in his inability to speak or write.

.4tt/0-suggestion is undoubtedly the direct cause of
stammering in some cases.1 It is the cause of stam-
mering when the subject has difficulty with only
one particular word but never with its homonyms or
derivatives. Thus the subject may stammer on
petroleum but not on petroleuse,2 on two, but not on

1 A number of writers have attributed stammering to auto-sug-
gestion. See Moll, "Hypnotism"; Quackenbos, "Hypnotism in
Mental and Moral Culture," etc.

* See Denhardt, " Das Stottern eine Psychose," p. 147.

3i6 THE PSYCHOLOGY OF STAMMERING

too or to. In such cases, stammering is directly in-
duced by auto-suggestion; but in the ordinary case of
stammering — i.e. in amnesic stammering — auto-
suggestion is operative only as a contributory or
secondary cause.

Auto-suggestion acts ordinarily by inhibiting voli-
tion. The subject firmly believes in his inability to per-
form a certain act, and therefore hesitates to attempt it.
Even after beginning, he is repeatedly deterred by
the conviction of his own impotence. As we have
already seen, Denhardt and Wyneken regard this
wavering of the will as the direct cause of stammering.
It is one of the principal causes. It renders the
stammerer constantly irresolute, and frequently pre-
vents him from observing a direct and progressive
procedure in the expression of even the simplest
thought. This fact is fittingly illustrated by a couple
of incidents that Denhardt records :

A young man wished to purchase a theatre-ticket
for the parquet, but fearing that he might stammer,
he began by asking for "ein Billet zum ersten Rang."
Then a moment later he feigned a change of mind,
and asked in the most casual manner for "ein Parkett-
billet."1

Denhardt then relates an incident in his own
. 2

experience

1 "Das Stottern eine Psychose," p. 46.
a Loc. cit., pp. 46-47.

FEAR AND AUTO-SUGGESTION 317

"This reminds me of a strategem that often rendered me
good service, when, as a boy, I had to purchase cigars for my
father. Upon entering the shop I walked to the open case,
which contained an assortment of cigars of which I knew the
prices perfectly well. In affected ignorance I pointed to and
inquired about a particular cigar that I had no intention of
buying. I repeated these tactics with one or two others till
I thought the propitious moment had arrived ; then I requested
the shop-girl to give me the particular brand of cigars that I
had been commissioned to buy."

Most stammerers could cite incidents of a like
nature in their own experience. These facts illus-
trate the point already made, — that the stammerer
often fails to observe a direct and progressive manner
of thought. There is endless vacillation of the will,
and the verbal image that should instigate oral
speech is constantly inhibited. The inhibition occurs,
too, after the stammerer has begun to speak, and in
this case it is directly responsible for the stammering.

Auto-suggestion can operate in another way.
When the stammerer expects to encounter difficulty
with a particular word, he attends to his stammering
rather than to his speech. Mental images of the ex-
pected stammering — labial effort, contraction of the
lingual muscles, etc. — then get to the focus of atten-
tion, and displace the normal verbal images. These
unnatural mental images, of course, express them-
selves in muscular movements, and stammering ensues.

Auto-suggestion thus induces stammering through

3i8 THE PSYCHOLOGY OF STAMMERING

the inhibition or the displacement of the normal
verbal image. It is probable that inhibition is itself
brought about only by the diversion of attention to
an obsessing image. The subject offers a rich field
for investigation.

Some stammerers find that they are able to speak
when they feel "compelled" to do so by the very
urgency of a situation. There are stammerers, for
instance, that speak well in public. Martin Tupper
never stammered when reading or reciting. Charles
Kingsley spoke well from the pulpit, but stammered
badly in conversation. The writer knows several
ministers that have this experience. One stammerer
of the writer's acquaintance is a successful amateur
actor; another is a talented orator and debater. A
probable reason for the stammerer's fluency under
coercive conditions is that he is seized with a deter-
mination to give unimpeded expression to thought,
and that he therefore ceases to vacillate, and redinte-
grates the verbal images in a consecutive and orderly
manner. It is doubtful whether this is the sole
reason for the stammerer's fluency. It is probable
that the very urgency of the situation really assists
the stammerer in overcoming his amnesia. This
phenomenon would not be surprising, for we find
that aphasic patients often break the bonds of silence
under the pressure of intense emotion. Unfortu-

FEAR AND AUTO-SUGGESTION 319

nately, the stammerer's speech often suffers in the
reaction, and a complete collapse follows the brief
subjugation of the impediment.

Stammerers that are able to suppress the impedi-
ment by sheer force of will are certainly in the minority.
The majority of stammerers experience fear that is
proportionate to the exigency of the circumstances,
and stammering is proportionate to the fear. This
is a somewhat perverse condition of affairs, but it is
nevertheless the condition that usually prevails.

Denhardt believes that the stammerer's fluency
or difficulty in speech under particular circumstances
is due entirely to the memory of the initial success
or failure. If the stammerer succeeds the first time
he talks from a platform, he is confident thereafter,
and consequently speaks with fluency. If he stam-
mers the first time, he fears further attempt ; hence
stammers on future occasions:

"The memory of success or failure has the greatest sig-
nificance in the life of the stammerer. Should he by chance
speak well at the beginning of the day, then the outlook for
the rest of the day is more favorable: the converse also is
true. If he stammers first on a p, he acquires a special fear
of this letter, and consequently has trouble with words that
begin with it. The effect of memory varies with the circum-
stances, and it is extraordinarily diverse in duration. The
effect may endure for hours, weeks, or months." 1

1 Denhardt, "Das Stottern eine Psychose," p. 84.

320 THE PSYCHOLOGY OF STAMMERING

EMOTIONAL ASSOCIATION

The effect of the initial success or failure is
explained "by emotional association. The fear or
assurance that originally accompanied a particular
circumstance is recalled by the recurrence of the
circumstance itself. The emotion then impedes or
facilitates speech. This emotional association ex-
plains the idiosyncratic differences among stam-
merers themselves.

Particular words, as well as particular circum-
stances, acquire associations that render them effective
mischief-makers. The word seems to acquire the
emotion of fear as one of the elements of the con-
cept. As soon as the word appears on the horizon
of consciousness, there occurs a deluge of emotion
that buries all verbal imagery by its very intensity.
Mental chaos and loss of muscular control then
render the stammerer impotent.

The fear of these particular words often takes the
form of a veritable phobia. The stammerer picks
out difficult words more or less consciously in silent
thought, and even frames his own verbal thoughts
to avoid them. He selects difficult words as he
listens to the conversation of another person, and
looks for his enemies while reading. This is lalo-
phobia in an unmitigated form.

Emotional association is one of the most potent

FEAR AND AUTO-SUGGESTION 321

influences in human life. An emotion that has ac-
companied a particular circumstance tends in a
remarkable way to be aroused by the recurrence of
the circumstance itself.1 The emotion seems to be
not merely aroused by the mental image or impres-
sion, but seems rather to become an integral part
of the concept.2 One surveys the scene of a former
accident with horror. One regards some detestable
creature with loathing, hatred, or fear. One regards
a friend with affection or esteem. The particular
circumstances that engendered these feelings may be
entirely forgotten. The emotion simply attaches
itself to the object and clings to it thereafter irrespec-
tive of the presence or absence of intelligent cognitive
memory.

Of all emotions, fear forms the most powerful asso-
ciations. The reason for this is evident. During
the early history of the race, a strong emotional as-
sociation of this nature would be a biological neces-
sity. The individual possessed of strong associa-
tions of fear would be likely to survive. On the
other hand, the individual that was devoid of this

'The converse of this principle is expressed in the proposition
that our thoughts are consistent with our moods.

'Many authorities hold that there is no "affective memory";
i.e. that there are no mental images of emotional experiences. They
believe that the emotions are revived in actuality and not in memory.
But even under these cirsumstances one could regard the awakened
emotion as one of the elements of the concept.

322 THE PSYCHOLOGY OF STAMMERING

emotional association would soon be eliminated.
Fear has thus been self -perpetuating ; and strong
fear-associations have come to be a racial heritage.
Many of these associations are ready-made : the fear
is instinctive, and occurs anterior to all experience.
"Secondary," or acquired, fears are established by
the experience of the individual; but they may
remain as quasi-instinctive fears after the incidents
that occasioned them are forgotten.

"Cases of strange and insurmountable fear or antipathy
have been noticed in some celebrated men: Scaliger was
seized with nervous trembling at the sight of the water-cress,
Bacon fainted during eclipses, Bayle at the sound of running
water, James I at the sight of a naked sword." l

Ribot supposes these fears to be due to the for-
gotten experiences of early childhood. Such instances
demonstrate the persistence of fear-associations.
Many of the phobias cited in the earlier part of the
chapter are manifestly due to individual experience,
and often to experiences that have been totally
forgotten.

Instinctive emotions, due to racial experience, are
common in both human beings and the lower animals.
The chick fears the hawk, though it has had no
encounter with the depredator. Most animals show
instinctive fear of their natural enemies. Gratilot
gave a very young puppy a fragment of wolf's skin
1 Ribot, "The Psychology of the Emotions," p. 216.

FEAR AND AUTO-SUGGESTION 323

so worn that it resembled parchment. When the
animal smelled it, he was seized with intense fear.1
In this case fear was aroused by a simple olfactory
stimulus. Instinctive fears are forever outcropping
in the human being. We see racial reverberations
in the fear of the dark and of water, in the dread of
high places and of solitude, in the fear of reptiles,
insects, fur, etc.

"Children who have been carefully guarded from all ghost-
stories are nevertheless terrified and cry if led into a dark place,
especially if sounds are made there. Even an adult can easily
observe that an uncomfortable timidity steals over him in a
lonely wood at night, although he may have the fixed con-
viction that not the slightest danger is near." *

These instinctive fears, of course, vary greatly in
different persons. In a few persons, most of the
instinctive fears are present. In others, only the
more common and "natural" fears are in evidence.
All degrees of variation are found between the two
extremes.

Fear as an emotion and an instinct has practically
outlived its usefulness. (This is true, at least, of the
emotion in its intenser forms.) Fear has been an
important factor in the evolution of the race, but
civilized races have now reached a point of develop-

1 Ribot, "The Psychology of the Emotions," p. 7.
•Schneider, "Der Menschliche Wille," p. 224; quoted by James,
"Principles of Psychology," Vol. II, p. 418.

324 THE PSYCHOLOGY OF STAMMERING

ment where instinctive fears and fear-associations
have little function to perform. Fear has become
an execrable heritage, for in most cases its function
is perverted, and the emotion is aroused by an entirely
inappropriate stimulus. As an instinct, fear is almost
an atavism; as an emotion aroused by associational
bonds, it it usually a curse. Fear makes it impos-
sible for one to accomplish the very thing in which
he dreads to fail.

Ribot holds that any fear is pathological when it
becomes hurtful rather than useful. Fere's criterion
of the morbid is the undue intensity of the emotion,
its unreasonable prolongation, and insufficiency of
the cause. According to these tests, most instinc-
tive and acquired fears are pathological when the
emotion reaches any considerable degree. The stam-
merer's fear is unquestionably pathological. In this
case all criteria are superfluous.

So much for instinctive fears and fear-associations.

THE NATURE OF FEAR

We shall consider now the intrinsic nature of fear and
of emotion in general. Emotion is usually regarded
as a purely mental phenomenon — as something that
one feels actually within the mind. The emotion
is thought to be aroused by its appropriate ob-
ject, and the physical disturbances to be aroused
in their turn by the emotion. The James-Lange

FEAR AND AUTO-SUGGESTION 325

theory,1 a theory that is now widely accepted by
psychologists, exactly reverses this sequence. It sup-
poses that the physical disturbances occur reflexly when
the stimulus appears, and that the emotion is nothing
more nor less than the feeling of these physical distur-
bances. That this is the more logical order of the
events should be evident from our previous discussion
of inherited instincts. An organism cannot inherit
knowledge : it is not aware, during its first experi-
ence, of the nature of the impending danger from
which it flees. When it flees, it merely reacts to an
emotional stimulus. The presence of the emotion can
be explained only on the ground that it consists in
the feeling of reflex physical disturbances. James
explains his theory concerning the sensory nature of
emotion as follows:2

"Our natural way of thinking about these coarser emotions
is that the mental perception of some fact excites the mental
affection called the emotion, and that this latter state of mind
gives rise to the bodily expression. My theory, on the con-
trary, is that the bodily changes follow directly the perception of
the exciting fact, and that our feeling of the same changes as they
occur, is the emotion. Common-sense says, we lose our fortune,
are sorry and weep ; we meet a bear, are frightened and run ;
we are insulted by a rival, are angry and strike. The hypoth-

1 For a complete discussion of this theory see C. Lange, "Ueber
Gemiithsbewegungen," Leipzig, 1887; and James, "Principles of
Psychology," Chap. XXV.

* "Principles of Psychology," Vol. II, pp. 440-450.

326 THE PSYCHOLOGY OF STAMMERING

esis here to be defended says that this order of sequence is
incorrect, that the one mental state is not immediately induced
by the other, that the bodily manifestation must first be inter-
posed between, and that the more rational statement is that
we feel sorry because we cry, angry because we strike, afraid
because we tremble, and not that we cry, strike, or tremble,
because we are sorry, angry, or fearful, as the case may be.
Without the bodily states following on the perception, the latter
would be purely cognitive in form, pale, colorless, destitute of
emotional warmth. We might then see the bear, and judge
it best to run, receive the insult and deem it right to strike,
but we should not actually feel afraid or angry."

That emotion is not a purely mental phenomenon
is evident from the fact that it is entirely independent
of cognition. Fear persists in spite of one's positive
belief in the non-existence of danger. Looking down
from the top of a monument, one trembles despite
the fact that he knows he cannot fall. He is behind
an iron railing, and could not fall if he wished; but
this knowledge does not inhibit the reflex visceral
changes, and consequently does not inhibit fear.
One trembles as a lion springs forward in his cage.
One knows perfectly well that there is no danger,
and may even feel ashamed at his own apparent
timidity ; yet he cannot suppress the reaction or the
corporeal changes that give rise to fear.

The bodily changes occur reflexly, and they are
but little under the control of the will. For this
reason intelligent reflection has little effect upon the

FEAR AND AUTO-SUGGESTION 327

feelings. The emotions of sorrow and anxiety that
one experiences in a theatre are not dispelled by the
thought that the fair maiden is paid so much a week
for being killed by the villain. One's sympathy with
the maiden and indignation at the villain are none
the less sincere. But the emotions cannot be con-
trolled even when things more serious are at stake.
A surgeon would scarcely undertake to operate on a
near and dear relative, for he knows that his fear and
anxiety cannot be subdued, and that his emotions —
try as he may to suppress them — will render him
impotent at a time when life and death depend upon
his self-control.

If an emotion were purely cognitive, there would
be no reason why it should ever cease. An insult
or a wrong is no less an insult or a wrong because it
was suffered a year ago. The loss of a friend is no
less a bereavement because it occurred in the past.
Yet such affairs of the past are usually viewed with
considerable sang-froid. The knowledge or cognition,
however, has not changed. The physical reactions
have merely worn themselves out.1

Introspection shows that emotion is nothing more
than the feeling of changes proceeding within the body:

"If one notices the uncomfortable mood brought about by
strained expectation, anxiety before a public address, vexa-

1 The intensity of the memory-images would have to be con-
sidered in a more thorough analysis of such cases.

328 THE PSYCHOLOGY OF STAMMERING

tion at an unmerited affront, etc., one finds that the suffering
part of it concentrates itself principally in the chest, and that
it consists in a soreness, hardly to be called pain, felt in the middle
of the breast and due to an unpleasant resistance which is offered
to the movements of inspiration and sets a limit to their extent.
The insufficiency of the diaphragm is obtruded upon conscious-
ness, and we try by the aid of the external voluntary chest
muscles to draw a deeper breath." 1

These physical changes giving rise to emotion are
usually so numerous and subtle that, as James says,
"the entire organism may be called a sounding-
board, which every change of consciousness, however
slight, makes reverberate." The feeling of these
changes alone constitutes the emotion. If the feel-
ings are subtracted, no emotional coloring remains.

"What kind of an emotion of fear would be left if the feeling
neither of the quickened heart-beats nor of shallow breathing,
neither of the trembling lips nor of weakened limbs, neither of
goose-flesh nor of visceral stirrings were present, it is quite
impossible for me to think. Can one fancy the state of rage
and picture no ebullition in the chest, no flushing of the face,
no dilation of the nostrils, no clenching of the teeth, no impulse
to vigorous action, but in their stead limp muscles, calm breath-
ing, and a placid face ? " *

It is manifest that if the physical feelings were
absent, the emotion would no longer exist. The
emotion of sorrow often has its nucleus in a "lump

1 James, " Principles of Psychology," Vol. II, p. 445 (quoting Henle,
"Natural History of the Sigh").
* James, loc. cit., p. 452.

FEAR AND AUTO-SUGGESTION 329

in the throat." A slight fear, as one slips on the stairs,
is often nothing more than a momentary "chill" in
the small of the back. Cutaneous shivering often
.constitutes the chief part of the emotion that one
feels when listening to poetry or music. A spinal
chill occurs when one listens to the grating of two
sharp steel edges. The chill is emotional in color-
ing; yet it is manifest that no emotion of a mental
nature is present.

The physical concomitants of emotion are often
very conspicuous. A severe fright may bleach the
hair, deprive one of consciousness, of sight, of speech,
or of the use of one or more of the limbs.1 A milder
fright will cure hiccups or drunkenness, — likewise
through the operation of corporeal changes. Blush-
ing may be "so intense as to cause a rash afterward ;
and, in rare cases, it may amount almost to vesica-
tion." 2

Emotion is due not merely to the grosser physical
changes within the body; but also to chemical
changes in the tissues and to activity in the various
glands. These chemical changes, as well as the
grosser physical changes, can often be artificially
induced. Drugs may transmute the whole nature of
the psychical mood. The imbibing of a little alcohol

1 In all but the first case, through the mediation of cerebral changes.
*G. Stanley Hall, "A Study of Fears" (Amer. Jour, of Psych.,
January, 1897).

330 THE PSYCHOLOGY OF STAMMERING

will change one's entire outlook upon the world.
Imbibing to excess inhibits the outlook entirely.
Hashish produces exaltation, and ipecacuanha in-
duces depression or fear.

Bodily diseases affect the moods. A bad case of
dyspepsia is apt to be as uncomfortable for the im-
mediate associates of the patient as it is for the patient
himself. Diabetes is often accompanied by depres-
sion, and phthisis by joyful spirits. These emotions
or moods are physical in origin : they are due to
chemical changes within the system. Morbid emo-
tional conditions are often due to disease. Mel-
ancholy may result from a blow upon the head;
cheerfulness returns when an operation relieves an
abnormal pressure on the brain.

"In every asylum we find examples of absolutely unmotived
fear, anger, melancholy, or conceit; and others of an equally
unmotived apathy, which persists in spite of the best of out-
ward reasons why it should give way." *

The thyroid gland, situated at the base of the larynx,
is in some inscrutable way intimately connected with
the emotional life of the human being. Diseases
of the thyroid gland are usually accompanied by
pronounced emotional disturbances. Of goitre, an
affection of this particular gland, Havelock Ellis

says : 2

1 James, loc. cit., p. 459.

1 "Man and Woman," 4th ed., p. 268.

FEAR AND AUTO-SUGGESTION 331

"The appearance of the patient suffering from this disease
— the staring protruded eyes, the breathlessness and rapid
heart, etc. — suggests a person suffering from terror, and it is
remarkable that fright has often formed the starting point of
the disease."

Graves' disease is a somewhat similar disorder ; and
the patient suffering from it presents all the symptoms
of extreme terror. The following is Dr. Mackenzie's
description of the malady : *

"Fright, intense grief, and other profound emotional dis-
turbances have been recognized as causes of the pathological
condition, but I do not think that sufficient attention has been
paid to the very close connection between the chronic symptoms
of Graves' disease and the more immediate effects of terror.
The descriptions given by Darwin and Sir Charles Bell of the
condition of man in intense fear might almost have been written
in regard to one of the patients we have been considering.
The heart beats quickly and violently, so that it palpitates or
knocks against the ribs. There is trembling of all the muscles
of the body. The eyes start forward, and the uncovered and
protruding eyeballs are fixed on the object of terror. The
surface breaks out into a cold clammy sweat. The intestines
are affected. The skin is flushed over the face and neck down
to the clavicles. The hair stands erect. 'Of all emotions,
fear notoriously is the most apt to induce trembling.' The
symptoms of terror are common to man and the lower animals.
There are one or two of the minor symptoms of Graves' dis-
ease whose independent occurrence under the influence of

1 Lancet, September, 1800. (Quoted by Ellis, " Man and Woman,"
4th ed., p. 269.)

332 THE PSYCHOLOGY OF STAMMERING

emotion is well known. These are pigmentary changes in the
skin and hair, falling out of the hair, and epistaxis."

Patients suffering from dyspepsia often manifest
the same symptoms. The physical changes being
present, they experience the emotion of fear ; and this
fear is in no way different from the fear that would
be aroused by the perception of some fear-inducing
object. The following is a description of the purely
physical fear of the dyspeptic :

"All physicians who have been much engaged in general
practice have seen cases of dyspepsia in which constant low
spirits and occasional attacks of terror rendered the patient's
condition pitiable in the extreme. I have observed these cases
often and have watched them closely, and I have never seen
greater suffering of any kind than I have witnessed during these
attacks. . . . Thus, a man is suffering from what we call
nervous dyspepsia. Some day, we will suppose in the middle of
the afternoon, without any warning or visible cause, one of these
attacks of terror comes on. The first thing the man feels is
great but vague discomfort. Then he notices that his heart
is beating much too violently. At the same time shocks or
flashes as of electrical discharges, so violent as to be almost
painful, pass one after another through his body and limbs.
Then in a few minutes he falls into a condition of the most in-
tense fear. He is not afraid of anything ; he is simply afraid.
His mind is perfectly clear. He looks for a cause of his wretched
condition, but sees none. Presently his terror is such that he
trembles violently and utters low moans; his body is damp
with perspiration; his mouth is perfectly dry; and at this
stage there are no tears in his eyes, though his suffering is in-

FEAR AND AUTO-SUGGESTION 333

tense. When the climax of the attack is reached and passed,
there is a copious flow of tears, or else a mental condition in
which the person weeps upon the least provocation. At this
stage a large quantity of pale urine is passed. Then the heart's
action becomes again normal, and the attack passes off." 1

The existence of these purely physiological fears
supplies the last link in our chain of evidence. It
should now be clear that emotion is nothing more than
the feeling of bodily changes that occur in response to
specific stimuli. With the origin of these changes we
are not concerned. The reader that is interested in
the matter is referred to special works on the psy-
chology of the emotions.2

In the next chapter we shall consider briefly the
possibility of controlling the physical reactions that
give rise to fear.

1 R. M. Bucke, "Man's Moral Nature," p. 97. (Quoted by James,
"Principles of Psychology," Vol. II, p. 460.)

1 Darwin, "The Origin of the Emotions"; Bain, "The Emotions
and the Will"; Ribot, "The Psychology of the Emotions"; James,
"The Principles of Psychology"; Spencer, "The Principles of Psy-
chology"; etc.

CHAPTER X

COROLLARIES

IN the foregoing chapters we have studied the causes
of stammering. In this chapter we have to consider
briefly in what measure these causes may be ob-
viated. The primary cause of stammering, it has
been shown, is transient auditory amnesia. The
secondary, or auxiliary, causes are bewilderment;
perversion of the verbal imagery ; auto-suggestion giv-
ing rise to inhibition of the will ; and, finally, fear.
The use of physical effort in speech might be regarded
as another of the mediate causes of stammering;
but the physical stammering to which it gives rise is
really an extraneous symptom. It must be differen-
tiated from the abnormal speech that reflects the
verbal imagery, and must receive its special form of
treatment.

It is at once evident that the secondary causes of
stammering are themselves effects of the primary cause.
If the primary cause, auditory amnesia, could be
removed, the secondary causes, fear, wavering of the
will, etc., would quickly vanish. The ' removal of
the amnesia is, then, of chief importance. However,

334

COROLLARIES 335

there can be little doubt that the secondary causes
are chiefly responsible for stammering in many cases.
When elocutionary methods effect a cure, as they do
in a few instances, there can be little amnesia in-
volved. One must conclude that in such cases the
secondary causes of stammering (the effects of the pri-
mary disturbance) persist after the auditory amnesia
has disappeared.

The stammerer must diagnose his own case, and
determine to what extent each of the several causes
conduces to the disturbance of his speech. If he
finds that little amnesia is present, he may be sure
that his defect of speech can be readily overcome.

We shall now consider the various secondary causes
of stammering, taking them in the order of conven-
ience. Afterward, we shall discuss the subject of
auditory amnesia, and the question of obviating it.
We begin with the discussion of fear.

FEAR

Fear, we have seen, is nothing more than the feel-
ing of certain physical changes going on within the
body. If these bodily changes could be prevented,
the emotion would not arise. Unfortunately, most
of the bodily organs in which these changes occur
are not under the direct control of the will. One may
change the facial expression, relax the tightened
muscles, and alter the respiration; but one cannot

336 THE PSYCHOLOGY OF STAMMERING

directly control the subtile activity of the internal
organs. Within certain limits, the internal changes
are subject to the influence of physical association;
but the changes cannot be directly inhibited, hence
the emotion cannot be directly controlled.

James advocates the practice of simulating an
opposite emotion. The argument is that the volun-
tary expression of the emotion induces, to some extent,
the involuntary physical changes, and that the volun-
tary and involuntary changes are then felt as a form
of the emotion simulated. It is evident that the un-
desirable emotion must be neutralized if the assumed
emotion is felt even to a slight degree, for the two
contrary emotions cannot coexist. James's remarks
on the subject are as follows : l

"Refuse to express a passion, and it dies. Count ten before
venting your anger, and its occasion seems ridiculous. Whist-
ling to keep up courage is no mere figure of speech. On the
other hand, sit all day in a moping posture, sigh, and reply to
everything with a dismal voice, and your melancholy lingers.
There is no more valuable precept in moral education than this,
as all who have experience know : if we wish to conquer unde-
sirable emotional tendencies in ourselves, we must assiduously,
and in the first instance cold-bloodedly, go through the out-
ward movements of those contrary dispositions which we prefer
to cultivate. The reward of persistence will infallibly come,
in the fading out of the sullenness or depression, and the advent
of real cheerfulness and kindliness in their stead. Smooth the

1 "Principles of Psychology," Vol. II, p. 463.

COROLLARIES 337

brow, brighten the eye, contract the dorsal rather than the
ventral aspect of the frame, and speak in a major key, pass the
genial compliment, and your heart must be frigid indeed if it
does not gradually thaw ! "

Emotions can sometimes be counteracted in a meas-
ure by deliberate analysis of them. Fear may lose
its prestige when it is viewed as an agglomeration
of bodily sensations. But the efficacy of self-analysis
is determined entirely by the temperament. With
some subjects it may be deleterious rather than bene-
ficial.

The stammerer must, as far as possible, annihilate
fear-associations — or, better, prevent their forming —
by deliberately ignoring failures and unpleasant in-
cidents. From the very nature of the human mind,
the act of disregarding such incidents must tend, by
weakening the associations, to exclude recollection of
them. Brooding over failures has the opposite effect.
It tends to imprint the incidents more deeply on the
mind, and to endow them with an emotional color-
ing that later exerts a pernicious influence.

The nature of the emotional life is largely deter-
mined by the physical condition. A person in ex-
cellent health is little subject to baseless fears. On
the other hand, the person that is "run down" and
"unstrung" is liable to all sorts of nervous and
emotional disturbances. Lowered vitality affects
the stammerer in a number of ways. It not only

338 THE PSYCHOLOGY OF STAMMERING

enhances his fear, but it aggravates the amnesia. The
amnesia and fear then aggravate each other.

Knowledge is the greatest counteractive of fear.
"By long consent, knowledge is power; still more
emphatically and specially, knowledge is composure"
(Bain). When the stammerer knows the cause of
his speech-disturbance, he feels less fear at its advent.
The impediment is more readily surmounted, and even
if it cannot be immediately overcome, it is at least
deprived of some of its terrors.

AUTO-SUGGESTION

If fear and auto-suggestion were the sole causes of
stammering, hypnotism would afford the natural
remedy for speech-defects.1 Many reliable hypno-
tists affirm that they have cured stammering by means
of suggestion, but the more reliable among them admit
that they have generally failed.

Hypnotism is used as an adjunct in some of the
"stammering-schools" of Europe, more particularly
in those of Germany. The hypnotists, however,
treat merely the fear and lack of confidence of the
stammerer; thus they miss the primary cause of

1 Hypnotism is still regarded by a good many people as a species
of black magic. This deplorable ignorance is largely imputable to
the sensational press and the freebooters of the vaudeville. An
exposition on hypnotism is beyond the scope of this work. The
reader wishing information on hypnotism is directed to monographs
dealing with the subject.

COROLLARIES 339

the speech-disturbance. The treatment would be
effectual if it were possible to intensify the auditory
imagery and to inhibit the amnesia by means of post-
hypnotic suggestion. This matter deserves thorough
investigation.1

During the past few years psychoanalysis has been
employed in Europe in the treatment of stammering,
- the stammering being regarded as a fear-neurosis.
The method of treatment seems to be no more effica-
cious than the old elocutionary methods. Various
"psychological" methods are vaunted by stammering-
schools in Germany, England, Switzerland, and Russia;
but these "methods" are generally little more than
advertising attractions, the principal "system" being
usually an elocutionary one. The psychological
methods may or may not possess inherent virtues ;
but they are usually applied by incompetents (men
that are neither physicians nor psychologists) ; hence
the success derived is generally nugatory.

Counter auto-suggestion is advocated by many
persons engaged in treating stammering. The stam-
merer is taught to combat his lack of confidence
with the counter-suggestions of "I can and I will,"
etc. The "I can and will" business is practically
the whole stock in trade of many illiterate "speech
specialists." The trouble is that under their malev-

1 The writer would be pleased to hear from investigators the re-
sults of any researches they may undertake in this field.

340 THE PSYCHOLOGY OF STAMMERING

olent treatment, the stammerer can't and doesn't.
Mere brute-will accomplishes nothing, for the stam-
merer does not know what he is trying to accomplish.
He tries merely to speak, without knowing anything
of the psychological process. When the mental
imagery fails, the sheer "I will" leads to physical
effort. Counter-suggestion, when applied in a general
way, is egregious nonsense. It may be efficacious in
counteracting fear and "delusional beliefs," but its
efficacy in any particular case will be determined
entirely by the temperament of the subject. A per-
son of emotional temperament might find counter-
suggestion extremely beneficial; but one possessed
of a cool, analytical mind would doubtless find it
futile. The former would do well to meet a difficult
situation with suggestions of his perfect confidence;
the latter would better refuse to think of the circum-
stance, — deliberately turning his thoughts to other
things and relying upon an intelligent comprehension
of the psychological speech-processes to tide him over
difficulties.1

MULTIPLE THOUGHT

There is no indirect method of attacking multiple
thought. The stammerer must simply realize that
the verbal imagery is absolute in determining the

1 The psychological systems currently employed in treating stam-
mering are discussed in Vol. II, Chap. VII.

COROLLARIES 341

nature of speech. If the verbal images are not ex-
pressed clearly in thought, and expressed in orderly
consecution, the oral words cannot under any pos-
sible circumstances be clearly spoken. The stam-
merer is always tempted to substitute synonyms for
difficult words. The expedient permits him to enjoy
a transient immunity from his impediment. Ulti-
mately, of course, the use of synonyms aggravates
the disturbance by increasing mental confusion.
The stammerer must on many occasions choose be-
tween two evils. He may speak the words that rise
first in his mind, and stammer whenever difficulty
occurs; or he may re-frame his sentence whenever
he encounters an obstacle. The latter course affords
temporary immunity; and, since it is the path of
least resistance, it is the one that the stammerer will
frequently follow. The former, however, is the only
possible course for the stammerer to pursue if he is
finally to overcome his difficulty.

When the impediment is severe, the stammerer
can readily overcome the tendency to employ syno-
nyms. He finds most words difficult ; consequently
it is an easy matter for him to treat them impartially.
When the disturbance is slight, the stammerer is
tempted to conceal his impediment by resorting to
synonyms. It is the stammerer of the latter type
that will have the greatest difficulty in restraining
multiple thought.

342 THE PSYCHOLOGY OF STAMMERING

It is not advisable for the average stammerer to
frame each sentence before speaking it, though he is
frequently advised to do so. This method of think-
ing the words first and speaking them afterward is
entirely unnatural. The average stammerer would
be tempted to pick and choose his words while fram-
ing the sentence, and confusion would ensue even in
this preliminary thought. Further, the appearance
of a difficult word in the sentence would augment the
speaker's fear and thus increase his predicament.
It is better for the stammerer to speak each word as it
rises in his mind and to treat difficult and easy words
impartially. If he is greatly tempted to replace
difficult words by synonyms, he might find it desir-
able (if he visualizes readily) to hold a visual image
of the refractory word before his mind. This image
would focus the attention, and to some extent counter-
act the tendency to substitute.

DISTORTION OF IMAGERY

Distorted verbal imagery is easily corrected if
the stammerer can find any circumstance under
which he can speak with fluency. Even if the
stammerer cannot speak with fluency when alone,
he can usually enunciate freely when speaking in
unison with another person, or when repeating the
words that another person has just uttered. Suffi-
cient practice in natural speech under these condi-

COROLLARIES 343

tions, or under any conditions, will restore the verbal
imagery.

Stammering that has been induced by imitation or
association is usually complicated by such secondary
causes as inhibitive auto-suggestion and fear. These
causes must, of course, be combated as well as the
distortion of the imagery. The stammerer must
determine for himself to what extent unnatural im-
agery is responsible for unnatural speech. If he
speaks fluently when alone, it is certain that the dis-
tortion of the imagery is not solely responsible for the
speech-disturbance, — unless, of course, he finds that
distorted images are redintegrated only in an un-
favorable environment. Such a condition of affairs
seems, however, highly improbable. In any case,
distorted imagery is easily rectified; and when the
impediment is due solely to this cause, it can be readily
overcome.

PHYSICAL STAMMERING

Physical stammering is easily eradicated by elocu-
tionary methods. In most cases it can be eliminated
in two or three weeks by careful training. By remov-
ing the secondary symptoms of amnesia, elocutionary
training often seems to effect a miraculous improve-
ment within a brief space of time ; but the improve-
ment seldom progresses to a cure, for the amnesia
remains unalleviated.

The intractability of a case is proportional to the

344 THE PSYCHOLOGY OF STAMMERING

severity of the amnesia and not to the severity of the
physical stammering. Bell has remarked that1 —

"A case of apparently slight impediment is frequently
more tedious and difficult to cure than one of the most bois-
terous and convulsive aspect." 2

The boisterous and convulsive aspect results from
physical stammering, and it can be readily eliminated.
It bears no necessary relation to the severity of the
amnesia. The amnesia may be severe and no physical
stammering be present. Liebmann says of a partic-
ular case of passive stammering : 3

"One can see plainly that the patient wishes to answer;
but she cannot do so, either aloud or in a whisper. One can
detect no articulatory movements, and the pneumograph shows
a normal respiration-curve. Only after some time does the
patient begin to speak; and then she does so in a fluent and
normal manner. The patient says that she knows the answer,
but is simply unable to say it." 4

In cases of this nature there is no physical stam-
mering, and elocutionary methods would be practi-
cally unavailing .

Of the elocutionary systems it may be said that
most of them will rectify the stammerer's errors of

1 "Principles of Speech," 5th ed., p. 236.

2 See also H. Gutzmann, "Sprachheilkunde," 26. ed., pp. 446-447.
1 "Vorlesungen iiber Sprachstorungen," i. Heft, p. 27.

4 See also p. 209 of this volume for Gutzmann's statement,
"There are stammerers that never stumble in speech, but that
summer, nevertheless."

COROLLARIES 345

respiration, phonation, and articulation; and that
most of them are therefore good so far as they go.
The trouble is that they do not go far enough: they
treat only the symptoms, but not the cause of the
speech-defect.

A detailed discussion of the merits and demerits of
the various systems is, of course, beyond the scope
of the present chapter : the subject has been reserved
for the succeeding volume. A few general remarks
at this point may, however, be pertinent.

It may be stated that the time-beating system —
which has its widest vogue in America — is directly
pernicious, since it distorts the stammerer's verbal
imagery.1

Many systems viciously overemphasize articulation,
and thus tend to confirm an erroneous attitude that
most stammerers have toward speech. The average
stammerer gives the greater part of his attention to sen-
sations from the speech-organs, and very little attention
to the verbal image by which the word is initiated. The
afferent stimuli, however, do not facilitate utterance ;
rather they divert attention from the point on which
it should be focussed. Hence any system that over-
emphasizes articulation is nocuous in such respect.

Under some elocutionary systems the pupil is taught
to note the words on which he stammers, and to
practise these words together with various alliterations
1 This remark applies to any system based upon rhythm.

346 THE PSYCHOLOGY OF STAMMERING

that introduce the "difficult consonants." The
practice is pernicious, since it establishes fear-associa-
tions. The stammerer acquires fear of certain words
and letters; and when these words or letters recur,
fear augments his difficulty. The practice develops
lalophobia, but does absolutely no good to compensate
for the evil it engenders.

PURE STAMMERING

It is evident that after the stammerer has overcome
physical stammering, distortion of the imagery,
multiple thought, fear, and inhibitive auto-suggestion

— all these being secondary causes or manifestations
of the defect — he has still the auditory amnesia to
contend with. At best he has reduced his complex
stammering to pure stammering : he has reduced the
disturbance to its lowest terms. But in many cases
no severe stammering will remain, and the slight
remnant of the defect may cause little inconvenience.
The auditory amnesia is often induced by the secon-
dary causes, and so may disappear when these causes
are removed. However, this is not invariably the
case; hence we have to consider the question of
obviating the amnesia itself.

Two questions naturally suggest themselves: First

— Can the refractory auditory image be goaded into
activity by artificial means ? Secondly — Can the
auditory image be strengthened so that it will be

COROLLARIES 347

less likely to vanish ? 1 These two questions must be
considered at length.

There seems to be no doubt that auditory sensa-
tions facilitate the redintegration of auditory images.
Paulhan remarks that the sound of a train or a water-
fall makes it easier for him to recall tunes in auditory
memory.2 Illusions of hearing are common, — un-
doubtedly more common than those of sight. This
fact shows that auditory images are easily awakened
by more or less irrelevant auditory impressions. In
certain cases one is absolutely dependent upon audi-
'tory sensations for the arousal of auditory images.
For instance, there are many people with weak audi-
tory imagery that can whistle a tune audibly, though
they cannot whistle in mental imagery. It is per-
fectly clear that they do not recall the tune in kin-
aesthetic imagery ; hence the auditory images of the
various notes must be aroused by the acoustic sen-
sations from the notes that precede them.

1 There can, of course, be no assumption of function by the op-
posite hemisphere of the brain. The defect in the auditory centre
appears to be usually functional rather than organic, and the stam-
merer is not incapacitated for silent thought. Hence, even in young
children no transference of function takes place. Any lesion that is
sufficiently severe to occasion transference of function is sufficiently
severe to induce aphasia rather than stammering. Transference of
function, in cases of stammering, is therefore out of the question.

*"Le langage inte'rieur" (Revue philosophiqtte, Janvier, 1866, p.
34). Cited by Ballet, "Le langage inte'rieur," 2d ed., p. 22.

348 THE PSYCHOLOGY OF STAMMERING

Most stammerers find that they can speak better in
the presence of sounds that the average person would
consider distracting. The noise of a train, the clatter
of vehicles, or the sound of voices seems to exert a
beneficial influence upon the stammerer's speech.
The sound of human voices is particularly salutary.
The average stammerer finds that he can speak with
unusual fluency if a number of persons happen to be
speaking within hearing-distance. The explanation
for this fluency is that the auditory sensations
facilitate the arousal of the auditory images requisite
for speech. It seems as though activity in the cells
subserving the sensations renders the contiguous cells
more excitable.

Lunn says : *

"It has often been remarked that deaf people hear best in
a noise, as in railway travelling."

Here, again, we must suppose that the extraneous
sounds assist in overcoming the inertia of the auditory
cells.

The fact that an acoustic sensation may awaken
the refractory auditory image affords a cogent reason
why the stammerer should commence the articula-
tion of a word even if its auditory image is not at once
forthcoming. The initial consonant can be produced
by kinaesthetic cues ; and the sound of this consonant

1 The Voice, Vol. V, p. 133.

COROLLARIES 349

will often arouse the indolent auditory image — or
intensify it if it should be too weak to prompt the
enunciation of a word. Further, the kinaesthetic
sensation tends to arouse the auditory image by as-
sociation. When the association is itself inadequate,
the sound-impression may often turn the balance.

There is another cogent reason why the stammerer
should commence the articulation of a refactory word.
The concentration of attention upon the word elimi-
nates multiple thought and vacillation of the will —
elements that might otherwise exert a disturbing in-
fluence. The procedure advocated will, of course,
occasionally introduce pure stammering in place of a
silent pause. On the other hand, it will often obviate
stammering and pauses entirely. Its advantages on
the whole greatly outweigh any disadvantages that it
might be thought to entail.

It is interesting to note that many empirical sys-
tems have taken advantage of this tendency of the
auditory sensation to awaken the sound-image. The
stammerer is frequently told to prelude his words
with a short e (8) or with the sound of the consonant
m or n. The word yes then becomes eh-yes, m-yes, or
n-yes. This artifice is thought to enable the stam-
merer to vocalize after the consonant has been articu-
lated, it being assumed that the stammerer's diffi-
culty lies with phonation. The vocalization is supposed
to continue during the articulation of the consonant,

350 THE PSYCHOLOGY OF STAMMERING

and the stammerer is admonished to maintain con-
tinuity of sound throughout the sentence. There can,
of course, be no such continuity, for vocalization ceases
with every surd consonant. If the initial consonant is
mute, vocalization is interrupted even between the in-
troductory sound and the vowel. It is thus evident
that the introductory sound does not perform the
function attributed to it. If it renders assistance at
all, it does so by arousing the torpid auditory image.1
It seems possible that the auditory image might
be aroused more readily if it were associated with
some visual image that could be clearly and promptly
redintegrated. The visual image would then form
a nucleus to which one could resort if the auditory
image were not at once forthcoming. It would hold
attention for the sound required, and tend to arouse
this sound by association. In many cases there seems
to be no difficulty whatever in reviving the auditory
image when an associated visual nucleus is present.
Many stammerers can read without difficulty, though
they cannot carry on a fluent conversation. It will
be remembered that even aphasic patients are some-
times able to read fluently when they are incapable
of spontaneous speech. The rationale of this seems
to be that the visual stimulus arouses the auditory

1 The stammerer is not recommended to resort to the unnatural
expedient described. This particular device is cited merely to
illustrate the principle under discussion.

COROLLARIES 351

image by association, or that it arouses the kin-
aesthetic image directly, acting itself as a remote in-
citing image. But whatever the subjective process
may be, it is certain that visual verbal images often
facilitate speech. The stammerer that can read with
fluency should have little difficulty in speech if he
could bring before his mind visual images of the words
that he utters. The process would be analogous to
ordinary reading.

Many subjects would have no difficulty in visualiz-
ing words during speech, but others would find the
visualizing of polysyllabic words practically impossible.
The idea naturally suggests itself that one might visu-
alize only the vowel, for the visual image of the vowel
should tend to arouse the mental image of its sound.
The phenomenon of chromaesthesia, or color-audition,
suggests further that one might visualize the printed
or written vowels in colors or upon colored back-
grounds. This would make visualization easier for
a person possessed of strong color-imagery, and in
many instances would facilitate visualization of the
entire word. This visualizing of colored words and
colored vowels, it will be remembered,1 is quite natural
with some persons; and when the color-imagery is
naturally strong, it does not prove at all distracting.
Galton says in reference to the phenomenon : 2

1 See p. 39.

l" Inquiries into Human Faculty and its Development," p. 148.

352 THE PSYCHOLOGY OF STAMMERING

"I will simply remark — First, that the persistence of colour
association with sounds is fully as remarkable as that of the
Number-Form with numbers. Secondly, that the vowel sounds
chiefly evoke them. Thirdly, that the seers are invariably
most minute in their description of the precise tint and hue of
the colour. They are never satisfied, for instance, with saying
'blue,' but will take a great deal of trouble to express or to
match the particular blue they mean. Fourthly, that no two
people agree, or hardly ever do so, as to the colour they associate
with the same sound. Lastly, that the tendency is very heredi-
tary."

Galton quotes the following description of vowel-
imagery by "Mrs. H., the married sister of a well-
known man of science " : l

"'I do not know how it is with others, but to me the colours
of vowels are so strongly marked that I hardly understand
their appearing of a different colour, or, what is nearly as bad,
colourless to any one. To me they are and always have been,
as long as I have known them, of the following tints : —

"'A, pure white, and like china in texture.

("E, red, not transparent; vermilion, with china- white,
would represent it.

" ' /, light bright yellow ; gamboge.

" '0, black, but transparent; the colour of deep water seen
through thick clear ice.

" ' U, purple.

" ' Y, a dingier colour than 7.

"'The shorter sounds of the vowels are less vivid and pure
in colour. Consonants are almost or quite colourless to me,
though there is some blackness about M .

1 Loc. cit., pp. 150-151.

COROLLARIES 353

"'Some association with U in the words blue and purple
may account for that colour, and possibly the E in red may have
to do with that also ; but I feel as if they were independent of
suggestions of that kind.

"'My first impulse is to say that the association lies solely
in the sounds of the vowels, in which connection I certainly
feel it most strongly; but then the thought of the distinct
redness of such a [printed or written] word as "great," shows
me that the relation must be visual as well as aural. The mean-
ing of words is so unavoidably associated with the sight of them,
that I think this association rather overrides the primitive
impression of the colour of the vowels, and the word "violet"
reminds me of its proper colour until I look at the word as a
mere collection of letters.

" 'Of my two daughters, one sees the colours quite differently
from this (A, blue; E, white; /, black; O, whity-brownish ;
U, opaque brown). The other is only heterodox on the A
and 0 ; A being with her black, and 0 white. My sister and
I never agreed about these colours, and I doubt whether my
two brothers feel the chromatic force of the vowels at all.' "

Another correspondent says that A is brown, vary-
ing in shade according to the "openness" of the vowel.
E is clear, cold, light-gray blue. / is associated with
black and O with white. The correspondent sug-
gests that the solid type in 7 and the open space in 0
may explain the colors with which these letters are
associated. R is copper-colored. This correspondent
gives the word visualization represented in streaks of
color, and proceeding conversely gives the verbal
interpretation of the colors in several scraps of wall-
paper.

354 THE PSYCHOLOGY OF STAMMERING

Obviously, it would be an easy matter for the stam-
merer to establish associations of this kind.1 The
associations would doubtless be beneficial to the
stammerer that is assisted by visual impressions in
reading. Theoretically, the associations should prove
beneficial in any case. The writer has made no in-
vestigations along this line. The matter has been
discussed merely to suggest a possible method by
which the auditory image might be aroused through
associational channels.

Many psychologists have expressed the opinion that
the mental imagery itself can be directly developed and
intensified. Unfortunately, most accounts of image-
training deal exclusively with the visual imagery.
However, it seems reasonable to suppose that if the
optical images can be developed, the acoustic images
can be developed also. For developing the visualiz-
ing faculty, Galton advocates the practice of retaining
the primary memory-image and examining it for
details that escaped observation during actual per-

1 The association is one of temporal contiguity. One must
receive simultaneous impressions through the sense of hearing and
the sense of sight. One pronounces the vowel-sound while looking
at the object (colored letter, solid color, or white letter on a colored
background) with which it is to be associated. Afterward, the
vowel-sound is associated with its letter or color in mental imagery.
For preference, the short vowels should be associated with the more
vivid colors.

COROLLARIES 355

ception. He also advocates the practice of multiply-
ing associations. Concerning the latter point he says : 1

"The chief art of strengthening visual as well as every form
of memory, lies in multiplying associations; the healthiest
memory being that in which all the associations are logical,
and toward which all the senses concur in their due proportion.
It is wonderful how much the vividness of a recollection is
increased when two or more lines of association are simulta-
neously excited. Thus the inside of a known house is much
better visualized when we are looking at its outside than when
we are away from it, and some chess-players have told me that
it is easier for them to play a game from memory when they
have a blank board before them than when they have not."

In another place the writer says : 2

"There is abundant evidence that the visualizing faculty
admits of being developed by education. The testimony on
which I would lay especial stress is derived from the published
experiences of M. Lecoq de Boisbaudran, late director of the
Ecole Nationale de Dessein, in Paris, which are related in his
" Education de la M£moire Pittoresque. " 3 He trained his pupils
with extraordinary success, beginning with the simplest figures.
They were made to study the models thoroughly before they
tried to draw them from memory. One favorite expedient was
to associate the sight memory with the muscular memory, by
making his pupils follow at a distance the outlines of the figures
with a pencil held in their hands. After three or four months'
practice their visual memory became greatly strengthened.
They had no difficulty in summoning images at will, in holding

1 Loc. tit., p. 108. * Loc. cit., pp. 105-106.

1 " Republished in an 8vo, entitled ' Enseignment Artistique.'
Morel et Cie, Paris, 1879."

356 THE PSYCHOLOGY OF STAMMERING

them steady, and in drawing them. Their copies were executed
with marvellous fidelity, as attested by a commission of the
Institute, appointed in 1852 to inquire into the matter, of which
the eminent painter Horace Vernet was a member. The present
Slade Professor of Fine Arts at University College, M. LSgros,
was a pupil of M. de Boisbaudran. He has expressed to me
his indebtedness to the system, and he has assured me of his
own success in teaching others in a somewhat similar way."

In spite of this opinion it seems to be a moot ques-
tion whether the visual images were actually intensi-
fied. Many of the subjects may have been motiles,
and their improvement in drawing may have been due
to the fact that they relied upon the motor as well as
the visual memory. However, Galton is not ambigu-
ous in his opinion concerning the possibility of in-
tensifying the visual images themselves, for he says : l

"I could mention instances within my own experience in
which the visualizing faculty has become strengthened by
practice; notably one of an eminent electrical engineer, who
had the power of recalling form with unusual precision, but not
color. A few weeks after he had replied to my questions, he
told me that my inquiries had induced him to practise his
color memory, and that he had done so with such success that
he was become quite an adept at it, and that the newly acquired
power was a source of much pleasure to him."

A single report of this kind is worth a hundred
general opinions concerning the possibility of training
the mental imagery. Unfortunately, such reports are

rare.

1 Loc. cit.t pp. 106-107.

COROLLARIES 357

An interesting account of "An Attempt to Train
the Visual Memory" appears in the American Journal
of Psychology.1 The writer says of her mental imagery
previous to the experiment :

"It was predominantly verbal-auditory and verbal-motor,
with the first factor a little in the lead.

" The direct visual memory was somewhat developed, though
not to the same degree as in most persons. E.g., the name of
some one whom I knew rather well would almost invariably
call up a visual image, and with some effort I could make its
details (form and color) fairly distinct. On the other hand, as
I now see upon looking back, class-names very seldom called
up a visual impression.

" My verbal- visual memory was very defective. Dates I or-
dinarily visualized, but not words. So far as I know, I had never
at this time had a visual picture of a written or printed word.
Of course it is possible, however, that just as one may have a
visual local sign without being aware of it until one's attention
is called to the matter, so I may have had visual-verbal images,
which served their purpose in associations without rising into
distinct consciousness."

When listening to reading, the writer was never
conscious of visualized words appearing before her
mind. She seemed to hear the words again hi her
own voice and feel them forming in her throat. This
imagery was, of course, both auditory and kin-
aesthetic.

The method pursued in developing the visualizing
faculty was to read a few lines of poetry; then to
1 Vol. vm, pp. 414 ff.

358 THE PSYCHOLOGY OF STAMMERING

close the eyes and give as full a description as possible
of the disposition of the lines and words, and any de-
tails that could be remembered. This description
was recorded, and its accuracy tested by reference to
the original page. In another exercise, Japanese
pictures were scrutinized for ten seconds and then
roughly sketched from memory, the sketch being
supplemented by an oral description. Comparison
was then made with the original.

Concerning the results at the end of six months'
practice, the writer says:

"With the poetry my work improved steadily from first
to last. At the outset six or seven lines was as much as I
could keep in mind at once ; near the close of the work I could
sometimes give from twenty to twenty-five without a mistake.
It must be confessed, however, that I did not always succeed
in making my memory purely visual; often I found myself
remembering the length of a line in terms of eye-movements.

"With the pictures the progress was not so evident. Natu-
rally it was harder in this case to say whether one was improving
or not ; especially as each picture in the set was given several
times. I am inclined to think there was a slight improve-
ment, but it certainly was not marked. . . .

"At the present time, seven months after the conclusion
of the work, I notice considerable improvement, both in the
direct visual and in the verbal-visual memory. In attempting
very recently to commit some poetry, I found myself depending
to a considerable extent upon my verbal-visual memory, whereas
a year and a half ago I should have relied wholly upon my
verbal-auditory and verbal-motor memories. The effect of
the change was apparent rather in greater accuracy than in in-

COROLLARIES 359

creased speed of memorizing. In my general reading, too, I
have more pictures than I used to have. I am not conscious
of visualizing any better than formerly — i.e., with any more
detail, — but I am conscious of visualizing more frequently."

One would judge from this report that there was
certainly no marked change in the intensity of the
visual images. The results do not strongly support
the notion that the mental images are always re-
sponsive to training. Nevertheless, opinions similar
to the following are frequently expressed by psy-
chologists : l

"It is astonishing to observe how rapidly this capacity for
visualising unfolds in response to a little systematic effort and
practice. By devoting to the task a few minutes each day for a
week, one may learn to visualise with great detail and remark-
able accuracy the form, size, color, etc., of even large and com-
plex objects, such, for example, as great buildings. Frequently
at the outset we find that our images are relatively faint, meagre,
and unstable; they lack vividness and veracity in color,
detail in form, and appropriate dimensions in size. Images of
other varieties, auditory, for instance, are similarly defective
at times, and yield as a rule to discipline with a corresponding
form of development."

Direct accounts of attempts to train the auditory
imagery are extremely rare in the literature of psy-
chology. General statements that the development
can be effected are, on the contrary, common enough.
The method to be pursued is evident. One must

1 Angell, "Psychology," pp. 218-219.

360 THE PSYCHOLOGY OF STAMMERING

attend closely to the auditory sensations (which
should be made as clear and sharp as possible), and
must allow the primary image to "ring" through the
mind. One must continually recall the image, and
must endeavor to preserve its fidelity. Secondary
memory-images must likewise be made the subject
of attention, and one must endeavor to increase the
intensity of the image with each repetition. The
whole matter is simply one of introspection and at-
tention. It is practically certain, however, that
whatever results may be accomplished by this method
do not endure unless the mental images are frequently
subjected to introspective scrutiny.

An ephemeral strengthening of the auditory imagery
seems to be effected by some of the more successful
systems of elocutionary training. This fact accounts
for the isolated temporary cures accomplished.1 For
several hours a day the stammerer is drilled upon
vocal exercises, many of which emphasize the vowel ;
and for several hours more he reads aloud in order to
comply with the requirements of the "system."
As a result of this practice the auditory imagery is

1 Other reasons for the "cures" can also be assigned. Fear and
physical stammering are generally eliminated, — the former by the
stammerer's confidence in the system, and the latter by the atten-
tion given to the conditions required for natural speech. Multiple
thought is also precluded for a time by the attention given to various
"rules of speech." Thus most of the secondary causes of stammering
are temporarily removed.

COROLLARIES 361

temporarily intensified, and stammering disappears.
When the exercises are discontinued or practised less
frequently, the auditory imagery reverts to its former
condition, and the stammerer relapses on account of
"carelessness."

It is not, however, merely to the intensification of
the auditory imagery that the stammerer must look
for relief. The auditory imagery is too unreliable
and treacherous to warrant confidence in any mitiga-
tion of the impediment that its transient intensity may
effect. With the occurrence of an illness the imagery is
often weakened, and stammering naturally recurs. It
is the usual experience of even the cured stammerer
that the impediment returns with its old vigor when
he is stricken with some debilitating disease. The
writer could cite several instances hi which principals
of "stammering-schools" have themselves suffered
a complete relapse. It is probable that such relapses
would be only temporary if the stammerer understood
the prevailing conditions. Fluency of speech would
return when the auditory imagery regained its former
intensity. However, the stammerer does not under-
stand the conditions ; hence he falls a victim to the
secondary causes.

But, if a complete and permanent cure is to be
effected, the stammerer must cease to be dependent
upon auditory images ; for, so long as he relies upon
these images as speech-cues, he must inevitably stam-

362 THE PSYCHOLOGY OF STAMMERING

mer when amnesia occurs. If it is possible, the stam-
merer must learn to depend upon kinaesthetic and
visual cues ; i.e. he must become an articulo-moteur
or a visuo-moteur. It is probable that the stam-
merer can never disregard his auditory images entirely,
but H he can supplement them by efficient motor
and visual speech-cues, he may be independent of the
auditory images when amnesia occurs. But the
acquired verbal images will be worthless if they can
be recalled only through association with the auditory
images. The acquired images must be established as
integral and independent parts of the verbal concept,
so that the stammerer can redintegrate them directly,
and speak, like the congenitally deaf person, from
kinaesthetic and visual cues.1

1The average stammerer would probably find it difficult to
develop his kinaesthetic verbal imagery by simply attending to the
sensations that the speech-movements produce. He might, how-
ever, be assisted by visualizing the movements he is endeavoring to
feel. He would probably find the kinsesthetic impressions from the
vowels more distinct if the acoustic sensations were excluded from
consciousness. This exclusion could not be accomplished by merely
sealing the ears. The vocal sound-waves would have to be obliterated
by other sound introduced to the auricular canals. (For this pur-
pose, some such simple apparatus as a stethoscope and an electrical
"buzzer" could be employed.)

The stammerer would establish his visual cues, like the deaf
person, by observing the action of the speech-organs in other sub-
jects, and by observing the action of his own speech-organs in the
mirror. (Literature on the training of the deaf can be obtained
from The Volta Bureau, Washington, B.C.) He might possibly

COROLLARIES 363

Teachers of the deaf have in the past often under-
taken the treatment of stammering, but they have
not generally met with success. The probable reason
for their failure is that they have attempted to teach
the stammerer to articulate (a thing that he can do
perfectly well), and that they have neglected the
secondary causes of stammering. The stammerer
does not need to be taught to articulate, for his
difficulty is merely to produce the correct color of the
vowel. If he is to discard his auditory imagery, he
must learn to mentally see and feel the different con-
formations of the oral cavity corresponding to the
vowels that he has formerly "heard." He has to
learn vowel-positions rather than consonant-move-
ments. Whether or not this can be readily accom-
plished, and whether the average stammerer can
voluntarily ignore his auditory imagery and deliber-
ately resort to artificially acquired cues, remains yet
to be ascertained by numerous actual experiments.

The writer has so far made no investigations along
this particular line. It is for the reason that he will
be unable to make extensive investigations in the
immediate future that he publishes the results of his

make some practical use of Bell's "visible speech" symbols. (See
Bell's "Visible Speech," etc.) If he visualizes readily, he might
picture the words in "visible speech," or in a combination of "visible
speech" vowels and ordinary alphabetic consonants. The field of
investigation is still unexplored, and it is difficult to state what the
most desirable procedure would be.

364 THE PSYCHOLOGY OF STAMMERING

researches while yet unable to supply the answer to
one of the vital questions involved. The writer does
not presume, however, to have solved the whole
problem of the cause and cure of stammering. This
monograph represents, in the main, an attempt to
explain the cause of stammering, and to indicate
the direction in which the writer believes the only
radical and reliable cure is to be found. It is hoped
that this volume will carry the necessary conviction
to stimulate investigation in the direction suggested.
Yet, whatever the success that may attend the visual
education of the stammerer, it is certain that the
logical method of handling the defect is to attack the
primary disturbance at its very inception — during
early childhood — and not first to await the develop-
ment of complications. If the amnesia is severe, the
child can be converted from an audito-moteur to an
articulo-moteur. If the amnesia is not severe, it can
generally be counteracted. If the child is taught to
suppress all excitement, and to think of the words
he is going to utter — to think how they are going to
sound — he can usually overcome his amnesia.
Childhood is the age of plasticity, and in early life
one accomplishes with consummate ease what in
later years becomes a matter of impossibility. If
the primary cause of stammering is allowed to persist,
the secondary causes quickly supervene, and pure
stammering becomes stammering in its complex form.

COROLLARIES 365

But even under these conditions, stammering is more
easily remedied at an early age.

A few of the progressive municipalities of Europe
and America have instituted special courses in the
public schools for the instruction of stammering chil-
dren. Where the system of instruction has not been
lacking in merit, the results have invariably been
propitious. The proportion of cures effected is in
some accounts given as high as 80 per cent. Even the
more conservative reports state that a majority of the
children are cured, and that a large proportion of those
not cured are greatly benefited by the instruction.1
There can be absolutely no doubt that in thousands
of cases stammering can be eradicated in early child-
hood, when it would not be amenable to treatment in
later life.

It is the obvious duty of every municipality to
institute courses of instruction for stammering chil-
dren, that later they be not "baffled at every turn of
life, for want of that most common privilege of man."

1 See Brockhaus Enzyklop&die (i4th ed., Vol. 17; article "Stam-
meln und Stottern"; also Medizinish-padagogische Monatsschrift far
die, gesamte Sprachheilkunde, May, 1894, and other issues; also
Werner's Magazine (New York), February, 1895.

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